Category Archives: Women’s Health
Cervical Cancer: Very Preventable
By: DELILAH MILLIGAN, CRNP
Cervical cancer was once the leading cause of cancer death for American women. Thanks to routine testing and vaccination, it is now largely preventable, but women of color still get and die from the disease at higher rates than other women.
Cause of cervical cancer
Cervical cancer occurs in the cells of the cervix — the lower part of the uterus that connects to the vagina. Most cases of cervical cancer are caused by the human papillomavirus (HPV), a sexually transmitted infection. Most people’s immune systems fight off HPV with no problem. In 10%-20% of women, however, the virus survives and can cause cervical cancer.
Routine Pap tests can detect precancerous conditions of the cervix, as well as early stages of cancer, and the HPV vaccine is effective in preventing the disease. With this combination, cervical cancer rates and deaths have declined by 75% in recent years.
Racial disparities in cervical cancer
Despite this good news, women of color are twice as likely to get and die from cervical cancer than white women. Reasons for this include disparities experienced by some minority women:
• Economic barriers to gynecologic care. Low-income women are less likely to be able to access health care, including cervical cancer screening.
• Even when they get a Pap test, minority women have less access to follow-up care. This makes them more likely to get a late-stage diagnosis of cervical cancer when successful treatment is more difficult.
• Black women are the least likely of any racial group to get the HPV vaccine. Barriers include limitations in insurance coverage, lack of information about the value of the HPV vaccine, and mistrust of the health care system.
Symptoms of cervical cancer
Early-stage cervical cancer generally has no symptoms. Signs of more advanced cancer include:
• Vaginal bleeding after intercourse, between periods, or after menopause
• Watery, bloody vaginal discharge that may be heavy and have a foul odor
• Pelvic pain or pain during intercourse
Reducing your risk of cervical cancer
• Receiving a vaccination to prevent HPV infection can reduce your risk of cervical cancer. Ask your doctor whether an HPV vaccine is right for you.
• Routine Pap tests can detect precancerous conditions of the cervix, as well as catch cancer early when it’s treatable. Begin Pap tests at age 21 and repeat them every few years.
• Prevent HPV and other sexually transmitted infections by practicing safe sex, such as using a condom every time.
• Smoking has been linked to cervical cancer, so if you smoke, talk to your doctor about ways to quit.
Delilah Milligan, Certified Registered Nurse Practitioner, received her Bachelor of Science in Nursing degree from Notre Dame of Maryland University and her Master of Science in Nursing degree from Chamberlain College of Nursing. She cares for patients in MPCP’s Glen Burnie office.
Racial Disparity in Breast Cancer
By: TRACY JANSEN, M.D.
Breast cancer rates among white women are higher than those for minority women, but black women are more likely to die from breast cancer. This article explains racial disparities in breast cancer and ways women can reduce their risk.
The basics of breast cancer
Breast cancer is a disease that causes cells in the breast to grow out of control. Breast cancer is the second most common cancer in women in the U.S. (after skin cancer). Deaths from breast cancer have declined over time, but remain the second leading cause of cancer death among women overall and the leading cause of cancer death among Hispanic women. Black women are 40% more likely to die from breast cancer than white women.
What puts you at risk
Your risk for breast cancer is due to a combination of factors. Some are lifestyle issues ‒ such as lack of exercise, obesity, and alcohol use ‒ but the two main factors are ones you can’t control: being a woman and getting older. Most breast cancers are found in women who are 50 years old or older. Your risk is also higher if you have a family history of breast or ovarian cancer.
Differences in breast cancer by race
- White women are slightly more likely to develop breast cancer than black, Hispanic and Asian women.
- Among older women, white women have higher rates of breast cancer compared to black women.
- Black women are more likely to develop more aggressive, more advanced-stage breast cancer that is diagnosed at a young age.
- Black women are more likely to have breast cancer diagnosed later when treatment options become limited and the survival rate is poor.
- Genetic factors may make black women more susceptible to certain types of cancer.
- Lifestyle factors – such as being overweight and not exercising – are linked to higher risk.
- High rates of type 2 diabetes in black women may be a factor. Women who had been diagnosed with diabetes at least five years prior to their breast cancer diagnosis were almost twice as likely to die of the breast cancer.
- Economic factors, such as lack of health insurance, limited access to medical care, and lack of access to nutritious foods, may contribute to higher cancer risk in minority women.
- Women who don’t breastfeed are at higher risk. Breastfeeding rates are lower among blacks than whites.
While there may be some factors you can’t control, such as a family history of breast cancer, there are steps you can take to lower your risk, whatever your race:
- Maintain a healthy weight. Ask your doctor about healthy ways to do this.
- Be physically active. Most healthy adults should aim for at least 150 minutes a week of moderate aerobic activity or 75 minutes of vigorous aerobic activity weekly.
- Limit alcohol. Limit yourself to no more than one drink a day, as even small amounts increase risk.
- Breast-feed. The longer you breast-feed, the greater the protective effect.
- Limit postmenopausal hormone therapy. Talk with your doctor about the risks and benefits of hormone therapy.
- Get screened. The American Cancer Society recommends women 45 to 54 get mammograms every year, and women 55 and older get them every one to two years.
Learn more about breast cancer and what you can do to lower your risk.
Dr. Jansen is an MPCP partner and is certified by the American Board of Family Medicine. She cares for patients at the Pasadena office.
Birth Control Methods – Pros and Cons
By Julie Henne-Reese, Certified Registered Nurse Practitioner
There are many birth control methods to choose from, but they differ in ease of use, cost and effectiveness. Some are available over the counter while others require a prescription or a medical procedure. MPCP offers several products, including birth control pills, implants (Implanon and Nexaplanon) and IUDs (Mirena and Skyla).
The chart below lists some of the most effective birth control methods, with pros and cons for their use. The descriptions are only an overview and do not contain complete information. Talk to your medical provider about these and other methods to determine what works best for you.
Keep in mind, most birth control products don’t prevent the spread of sexually transmitted diseases (STDs). Your medical provider can advise you on how to stay safe.
Which Method is Right for You?
| Method | Effectiveness | Features | Pros | Cons |
|---|---|---|---|---|
| Birth Control Implant | 99% | Matchstick-sized rod that doctor places under the skin of woman's upper arm. Releases hormone to prevent pregnancy | Lasts 3-5 years. You don’t have to think about it | More expensive than other methods |
| IUD (Intrauterine Device) | 99% | Placed inside the uterus to prevent conception | Lasts 5-10 years. Low maintenance | More expensive, may cause irregular/heavy periods |
| Vasectomy | 99% | For men. Doctor surgically closes the tubes that carry sperm from the testes | Does not affect ejaculation | May not be reversible, more expensive |
| Tubal Ligation | 99% | Surgeon closes off the fallopian tubes, preventing eggs from leaving the ovaries | Very effective | May not be reversible, more expensive |
| Tubal Implants | 99% | Doctor puts a small metal or silicone implant inside each fallopian tube, blocking them and preventing ovulation test | Very effective, doesn’t require surgery | Not reversible, more expensive |
| Birth Control Shot | 97% | Hormonal shot protects against pregnancy for three months. It is injected four times a year | Since you don’t have to think about it, is usually better than birth control pills | More expensive. May cause spotting and other side effects |
| Birth Control Pill | 92%-95% | Uses female hormones estrogen or progestin to prevent ovulation | Very effective if used right. May cause more regular, lighter periods, or no periods | May cause breast tenderness, spotting, blood clots and raised blood pressure |
| Vaginal Ring | 92%-95% | Soft plastic ring goes inside the vagina. It releases the same hormones as the pill. A woman replaces it herself once a month | Works as well as the pill. May cause lighter, more regular periods | May cause vaginal irritation or other side effects similar to the pill |
| Male Condom | 84-89% | Latex condom blocks sperm from entering the woman's body | Inexpensive. One of the few birth control methods to prevent sexually transmitted diseases | Not reusable. Effective only if used correctly every time |
| Diaphragm | 84-89% | Rubber dome that a woman places over her cervix before sex. It is used with spermicide | Inexpensive | Doctor must initially fit it to ensure proper function |
| Cervical Cap | 84-89% | Similar to a diaphragm but smaller. Slips into place over the cervix. Used with spermicide | Inexpensive, can stay in place for 48 hours | Doctor must initially fit it to ensure proper function |
| Birth Control Sponge | 84-89% | Made of foam and contains spermicide. A woman can place it against her cervix up to 24 hours before sex | Effective immediately. Works about as well as the cervical cap | Can be hard to put in |
Julie Henne-Reese, Certified Registered Nurse Practitioner, is board certified by the American Nurses Credentialing Center in Family Practice. She sees patients in MPCP’s Queenstown office.
Share the Warning Signs
A Q&A on Ovarian Cancer with Llyern Bartholomew, CRNP
Q: Isn’t Ovarian Cancer called the “silent killer” because it has no significant symptoms?
That’s a bad misnomer that we need to discard. Ovarian cancer clearly has symptoms; they are just more subtle in the early stages so it’s important that a woman listens to and knows her body. Ovarian cancer is the number one killer of all the reproductive-organ cancers so we need more education in terms of early warning signs.
Q: So what symptoms should women take note of?
The five most common symptoms are:
- abdominal bloating or swelling
- quickly feeling full while eating
- changing bowel or bladder habits, particularly the need to urinate more frequently
- discomfort in the pelvis area or low back
- weight gain or loss
It’s not unusual to have one or two of these symptoms occur occasionally. But, if you have two or more of these symptoms daily for more than 2 weeks, it’s time to call your doctor.
Q: How do doctors diagnose Ovarian Cancer?
The first step is a pelvic exam. Then, your doctor may order a transvaginal sonogram or an ultrasound of your abdomen and pelvis. We can also use a blood test that detects a protein identified with cancerous cells. In some cases, a tissue biopsy and study of fluid from the ovaries will be recommended.
As with all cancers, earlier detection provides more treatment options and a higher cure rate, so please share this information with all the women in your life!
Llyern Bartholomew, CRNP practices at the MPCP Glen Burnie office.
