The Womens Group Newsletter
- Designer
Estrogens
- Breastfeeding in Public
- Pap after Hysterectomy
- "The best just got Better",
A New Pap Technique
Written by: Gretchen Frey, M.D.
Well, now you've heard it all, right? As if designer clothing, sunglasses, and even
linens weren't enough, now there's talk in the media about "designer" estrogens.
This column will give you some insight into what the fuss is all about.
Q. Why the desire to develop different forms of estrogen?
A. Breast cancer is the most frequent cancer in women (though not the most frequent cause
of cancer death). It is estimated that one in nine American women will get breast cancer
at some point in their lives. Estrogens play an important (though not fully understood)
role in the development and growth of breast cancer. Therefore, much interest has been
focused on the mechanisms of estrogen action and the development of artificial estrogen
agents which block estrogen synthesis. These are known as Selective Estrogen Receptor
Modulators, or SERMs (alias "designer estrogens”).
Q. What exactly are SERMs and how do they work?
A. These new medicines are not really hormones, but they have the ability to activate or
block certain estrogen receptors in the body. Therefore, they can mimic some of the
beneficial effects of hormones or block some of the harmful effects of those same
hormones.
Q. What are some examples of SERMs?
A. The best known SERM is Nolvadex (tamoxifen), used for many years now in breast cancer
patients. This drug can bind to the estrogen receptors of breast cancer cells, preventing
the body's own estrogen from occupying the same sites, where it might cause the cells to
grow. Tamoxifen acts as an "anti-estrogen " in bthis way, working to block tumor
growth and spread. In about 10% of women, however, it can stimulate estrogen receptors in
the uterus, which can increase the woman's risk of developing uterine cancer.
There is another SERM developed for the purpose of hormone replacement in patients
without breast cancer. It is called Evista (raloxifene), though it has acquired the
nickname "estrogen light". It may turn out to be a better choice than
traditional estrogen replacement therapy for some women. Here, the aim is to provide the
clear benefits of estrogen replacement therapy while minimizing some of the possible risks
(mainly possible increased risk of breast cancer) in women felt to be especially prone to
the disease.
Another drug, also developed for the treatment of breast cancer, is Fareston
(toremifine citrate). Like Nolvadex, Fareston is also an anti-estrogen. It is the first
new anti-estrogen developed for breast cancer in 18 years. Preliminary studies show no
evidence of secondary cancers related to it's use. It has the additional advantage of
being a once a day medicine (Nolvadex is twice a day). In the battle against breast
cancer, Fareston is a welcome addition to the fight, one that will add
much needed hope and encouragement.
We will keep you informed in our newsletters as clinical experience with these
medications increases. Sorry, no word on a Ralph Lauren line of estrogens yet!
By Felicity Thompson, Certified Nurse Midwife
Once a decision is made to breastfeed, most women find that they are able
to relax and nurse with ease and confidence in the privacy of their own home. Many women
do not feel quite so confident about nursing in public, however. Whether from
embarrassment over the possibility of exposing themselves in public, or from fear of
embarrassing others, many women are hesitant to attempt to breastfeed outside the privacy
of home. Rather than become housebound, or be forced to offer bottles in public
situations, consider learning to nurse discreetly, and be proud of the fact that you are
offering your baby the best possible nutrition at all times!
Here are some tips to help you feel confident about nursing
discreetly no matter where you are:
1. Practice going to the homes of a few trusted friends to help you learn to relax away
from the comfortable familiarity of home.
2. Dress with care to ensure that your clothing allows easy, discreet access to your
breasts. Consider purchasing a few nursing tops these are specially designed to make
nursing access easy, and are available in a variety of styles. If you have trouble finding
a good selection locally, we have catalogs available here in the office.
3. When eating out with your baby, request a table in a quiet corner, and seat yourself
with your back to the busiest area. Consider your menu selection and order something,
which will be easy to eat with one hand, if necessary.
4. Learn to anticipate your baby's hunger signals, and offer your breast before they
are howling to eat; those hungry cries are sure to draw unwanted attention your way.
5. If you find it difficult to walk, shop, and nurse simultaneously, consider taking a
break in a lounge or restroom. Even a changing room can double as a private nursing booth,
if need be.
6. If you find yourself in a crowd with a hungry baby, simply help your baby latch on ,
and then resume eye contact with your companion, or strike up a conversation. Watching
your baby nurse will only draw attention to what you're doing. Carry a small blanket or
shawl to cover yourself and your baby, practice this at home so that baby does not mind
the cover
7. Last but not least, relax and remember that you are doing a wonderful thing for your
baby!
By Dr. Beth Aparicio
This is a question many women have asked throughout time. There are some basic
guidelines to follow to answer this question.
You should continue to get yearly pap smears if you have a history of any of the
following:
1) Cervical cancer
2) Cervical dysplasia (all types)
3) Genital warts / condyloma
4) HPV
5) DES exposure
If you have not had any of the above, there is debate as to the appropriate interval
for pap smears. Many physicians recommend screening once every 3 years. However, recent
studies have shown there may not be a need for any further pap smears. Even if you do not
need annual paps, it is still important be seen yearly for breast and pelvic exams
(especially if your ovaries are still present).
By Nancy Rudd-McCoy, MD.
We have been pleased since we began sending all our paps to the Swedish hospital
pathologists, because we have seen an improvement in accuracy: fewer scares, a better
correlation between pap smears and biopsy results, and so far no missed disease.
Nevertheless, these colleagues are going to switch to newer technology, the Thin Prep.
From the patient's point of view, obtaining the sample is no more intrusive. In stead of
the provider spreading the sample on a slide, she puts it directly into a test tube of
fixative. The pathologists later spin this down to get the cells onto a slide. This
results in a "cleaner", clearer specimen for evaluation, with statistically
fewer missed diagnoses (false negatives) and overdiagnoses (false positives).
Whether or not insurance covers this new technique above and beyond the standard
method, a flat rate will cover all paps.
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