Can the intake of antioxidants decrease my risk of breast cancer?

In most areas of medicine, prevention is foremost in discussions about any disease process. October is Breast Cancer Awareness Month, and while most of the focus is on early detection and advances in treatment, we’d like to briefly review new information regarding possible prevention.

The focus on detection and treatment is understandable from the viewpoint that little is yet known about what causes breast cancer or what can be done to lower an individual’s risk for developing the disease. It has long been known that there are some things that are associated with a lowered lifetime risk, such as younger age at first childbearing, breastfeeding your infants, or absence of a family history of the disease. The problem is that these are only associations and therefore not really modifiable – women do not plan childbearing at an early age to lower their lifetime risk of breast cancer. And unlike many other disease processes, there is pathetically little that can be offered in the way of a modifiable lifestyle that has been shown to lower the risk of developing breast cancer.

It is for this reason that a recent article in the International Journal of Cancer caught our attention. A group of researchers at USC studied the association of green tea intake and the risk of breast cancer in Asian women. There were two reasons for their interest. First, Asian women are known to have a substantially lower risk than other nationalities of developing breast cancer and their diet traditionally includes the regular intake of green tea. Second, green tea has high concentrations of certain antioxidants. Research over the last several years has increasingly focused on the potential role of antioxidants in preventing the development of cancer. Cancer theory suggests that one of the undesirable byproducts of cell metabolism is the release of chemicals, called free radicals, that damage DNA. Cumulative damage disrupts cellular function and is felt to be a key step in the cells becoming cancerous. Antioxidants are compounds that inactivate these free radicals. Less cellular damage occurs and, theoretically, the risk of cancer decreases.

Many compounds function as antioxidants. The ones in green tea are called polyphenols (these compounds are present in all tea leaves but are destroyed in the processing of black tea, the ordinary tea most Americans drink). The researchers studied a group of Asian women in southern California who had developed breast cancer and compared them with other Asian women from the same area who had not developed the disease. They showed an inverse relationship between green tea consumption and the risk of breast cancer. That is, the higher the intake of green tea, the lower the risk of developing breast cancer. Interestingly, the actual amount of green tea consumed by these Asian-American women was not all that high. Only 1 in 5 women drank it 5 or more days a week, and a protective effect was seen even with lower consumption than this. According to their data, women who consumed the higher level (>5 cups per week) had a relative risk of developing breast cancer almost 50% lower than those who drank none. Women consuming <5 cups per week still demonstrated an almost 30% risk reduction. Also of note was the fact the lowered risk was seen even in women who had other risk factors that would, statistically anyway, increase their breast cancer risk such as a family history of breast cancer and increased level of alcohol intake. As one more side issue evaluated in this study, they looked at the association of soy intake to see if it also had any effect on the risk of breast cancer. Soy is a food source also traditionally consumed in greater quantities by Asians. It contains significant amounts of a different group of antioxidants. An inverse association was again seen. The protective effect was noted in women who did not consume green tea-which supports other research on the beneficial effect of soy products. What to infer from this? This does not imply a radical diet change is indicated. What it does do is begin to define a proactive change in diet that specifically addresses a woman’s breast cancer risk. For too long we have had little or nothing to offer as preventive guidance in this area. The gradual addition of green tea and soy products is a reasonable start.

SONOHYSTEROGRAM: What is a sonohysterogram?

What is a sonohysterogram?

Sonohysterograms are performed to evaluate the uterine cavity. A few milliliters of sterile fluid are inserted into the cavity of the uterus. This slightly distends the cavity and allows us to examine whether the wall and lining of the endometrium is smooth or irregular. Sonohysterograms can verify the presence of a uterine fibroid, septum, polyp, or thickening of the endometrial lining, and can possibly avoid the need for a diagnostic surgical procedure.

How is it performed?

A speculum is placed into the vagina and the cervix is wiped with a disinfecting soap. A very thin flexible plastic tube is inserted inside the cervix. The tube is similar to the size of a spaghetti noodle. Few patients can tell when the tube is inserted aside from the fact that you may experience a slight cramping or tugging sensation. The speculum is removed, and the vaginal ultrasound transducer is inserted into the vagina. Sterile water will then be injected through the tubing, which will distend the uterine cavity and allow for direct real time visualization. Typically we use less than two tablespoons of sterile fluid to completely visualize the cavity. After all necessary information is obtained the ultrasound transducer and tubing are removed. Most times the entire study will take less than 15 minutes and patient discomfort is minimal

Preparation for the exam:

No special preparation is required for a sonohysterogram. You do not need to have a full bladder and you do not need to drink before the exam.

The results are discussed immediately following the procedure, and you may resume normal activities.

Genital Herpes: Common Questions

What is herpes?

The herpes simplex virus (HSV) is a common infection which can infect the mouth (usually HSV-1) or the genitalia (usually HSV-2). Genital herpes is transmitted by direct skin-to-skin contact with an infected partner. When symptoms are present (and actually, this is the minority of cases), genital herpes is hallmarked by small, ulcerated, and often painful lesions in the genital area. It is also common to have pain or swelling in the groin, pain with urination, and/or flu-like symptoms such as headache, fever, or muscle aches. However, most people are unaware if they have or have had herpes, as symptoms may be very minimal or absent. This is called “subclinical infection.”

I have a lesion on my genitals that seems new – how do I know if this is herpes?

The best way to determine whether or not a new change on the genitals is herpes is to be examined by a clinician who has experience in diagnosing different skin/genital infections. At that time, your provider may obtain a “culture” which is a specific test for herpes. Though this is not 100% sensitive in picking up a herpes lesion, the combination of a visual exam and a culture and sometimes serologic (blood) testing can usually correctly diagnose a herpes lesion.

I don’t have any suspicious lesions now, but how do I know if I have had herpes in the past?

It is possible to perform serologic testing which is designed to see if your body has made antibodies to either HSV-1 or HSV-2 in the past. Usually, these tests are able to distinguish between a past and current infection as well. However, these tests are not perfect and can miss infection. Therefore, it is important to first talk with your provider about your history, and whether or not any further testing is necessary.

My partner occasionally gets cold sores on his lip. He has been told that this is herpes. Can I contract herpes from him on my mouth or genitals?

Yes, if your partner has a sore around the mouth, it very well could be related to the herpes virus – most likely HSV-1. If you engage in any mouth-to-mouth or mouth-to-genital contact, it is possible to transmit the virus this way. However, it is uncommon that this type of viral transmission (HSV-1) will progress to become a chronic issue in terms of future genital outbreaks.

I was told that I was having a herpes outbreak many years ago while I was in college. I have never had another outbreak since and feel no symptoms of herpes. I am just beginning a new relationship – what should I tell my partner?

Though it is always very difficult to discuss herpes or any history of a sexually transmitted infection, it is important to find a way to have this conversation. Keep in mind that your partner has a 25% chance of already being infected with the virus, even if he or she has never had a known outbreak. You could suggest that your partner be screened with a blood test before assuming that you are infected and your partner is not. If you confirm that you have been infected and your partner has not, efforts should be made to prevent transmission. If you do have signs or symptoms of an active outbreak, then intercourse should be avoided. If there are no signs or symptoms of an active outbreak, it is still possible (though less likely) to infect a partner. This is because of “asymptomatic shedding,” which means that your genitals are shedding the virus but you have no symptoms. Because of this possibility the best form of protection is the use of condoms, as it creates a barrier between the genital tissues. Though condoms do not prevent transmission 100% of the time, it is the most helpful way to prevent transmission.

I had a primary herpes outbreak about a year ago. Since then, I have an outbreak almost every month, usually around the time of my period. What can I do about these outbreaks?

For women infected with HSV-2 (the most common cause for genital herpes), it is not uncommon to experience recurrent outbreaks. Often, women have outbreaks around their menses as a result of hormonal changes. The other very important factor which has a great bearing on how frequently or severely a woman experiences outbreaks is her overall wellness and immune system. When a person’s immune system is impaired for any reason, the body has a harder time managing any virus, and therefore someone infected with herpes can have more frequent or extreme outbreaks. Things that can weaken your immune system include smoking, inadequate rest, stress, malnutrition, or chronic illness such as HIV, diabetes, or cancer. If you know that you have herpes, it is important to try to eliminate stressors to the body so as to keep your immune system strong. Additionally, there are medications called “antivirals” available, which can significantly improve the frequency and intensity of herpes outbreaks. For a person who has an occasional outbreak the use of medication can shorten the length and intensity of the outbreak, especially when taken at the first signs of an outbreak. For a person who has chronic monthly outbreaks, it is sometimes recommended that medication be taken on a daily basis to “suppress” the outbreaks.

Please feel free to talk with your healthcare provider about the possible use of medication if you have herpes outbreaks.

In the future we will discuss herpes in pregnancy.

Lyme Disease – How can I protect myself?

Lyme disease is endemic to the seacoast. As the peak incidence of the disease occurs in July, lets look at what generally can be done to lower your risk of the disease.

Lyme disease is a bacterial infection spread to humans by the bite of a particular tick, commonly known as the Deer Tick (Ixodes scapularis in this part of the country). The tick lives primarily on deer and the white-footed mouse, humans, as incidental hosts, are susceptible to the disease. Those at greatest risk live in areas where deer abound. Other than in winter months, the disease can be contracted throughout the year. The majority of infections (80%) occur from April through August reflecting the higher risk of infection from the younger (nymph) tick bites.

It’s important to remember that the vast majority of tick bites do not result in infection. Ticks must go undetected and remain attached for long periods (generally at least 36 hours) before infection can occur. The bacteria that causes the disease (Borrelia burgdorferi) is very susceptible to commonly used antibiotics (penicillin and tetracycline) so the disease remains not only readily treatable but also preventable with small prophylactic doses of antibiotics (see below).

Prevention strategies focus on lowering exposure risk, detecting and removing ticks, possible use of prophylactics, antibiotics, and early recognition of signs and symptoms of the disease.

Minimize exposure: Obviously areas of deer habitation pose the greatest risk. But with increasing population of both humans and deer in the seacoast most rural areas remain at risk. When wearing long pants remember to tuck pant legs into socks and the use of repellants has also been shown to work. Some people advocate, in areas of high deer/tick population, the use of chemical agents ( known as acaricides) over the entire yard. Application is recommended in May and has been shown to markedly reduce tick populations. Applications need to be repeated and should be done by professionals. Simple measures like a border of wood-chips where the lawn abuts the woods also, for some reason, reduces the number of ticks that inhabit the lawn. Some communities are experiencing with treating the mouse host e.g. with bait boxes chemically treated with a substance to kill the ticks.

Detecting and removing ticks: This is extremely important. Careful evaluation of yourself and your children should become routine. The ticks are very small, only 3-4mm in size, and the younger (nymph) ticks is even smaller. All however, enlarge markedly when engorged with blood and become much more detectable. Removal is by gently traction (in order not to dislodge the head): The use of petroleum jelly or a hot match is not recommended. And remember, the tick must remain attached for many hours in order to transmit infection: you don’t need to check for ticks several times a day, just on a regular, daily basis.

Prophylactic antibiotics: There are uncertain situations where the use of a single, preventative dose of antibiotic (usually 200mg of doxycycline , a tetracycline) has been shown to work. These are used if the tick has been attached for over 36 hours, or when an engorged tick is discovered. If you remove the tick yourself, save it to show your treating physician (primary care, pediatrician ,ER physician )and seek treatment within 72 hours.

Early recognition of signs and symptoms: Only about 30% of people diagnosed with Lyme disease recall a bite, so you need to be aware of the primary disease manifestations. These fall into four main areas: dermatological (skin)(seen in the early phase), neurologic, cardiac and joint related (seen in later phases of the infection).

Dermatological signs are the most common with a rash seen in 60-80% of infections. The rash is an expanding red rash whose central area can initially be bright red, blister-like or firm, but later develops a characteristic “central clearing” (i.e. The central area appear normal.) Other insects/spider bites, fungal infections or plant allergies can mimic the rash. Have the rash examined by a qualified provider. The rash is sometimes associated with other symptoms of acute infection such as low-grade fever, swollen lymph glands, neck stiffness malaise/fatigue or joint pain.

Neurologic symptoms may develop in patients who do not recognize and treat early disease. This is often first seen as Bells Palsy (acute facial paralysis). Meningitis may also develop. This presents usually as a persistent headache associated with other symptoms such as memory loss, poor concentrations, sleep disturbance, confusion irritability and/or behavioral/mood disturbances. The other neurologic symptom that is seen is what is called radiculoneuritis – the development of a painful limb, typically a stabbing or burning pains.

Cardiac symptoms are less common and are usually seen as the development of heart block – a profound slowing of the heart rhythm. It is not commonly seen ( in perhaps 5-10% of late disease) but should be evaluated immediately.

Finally joint symptoms are seen. These again develop after the initial infection and while they may develop within a month, they are known to occur many months or even 1-2 years after initial disease. Like many forms of arthritis, this is seen as a painful, swollen, joint.

In summary, the disease is not very common and is very treatable with rare long term or permanent effects. Try to focus on prevention, in particular looking for and removing ticks, and on early recognition, especially the rash. Seek prompt medical attention for any suggestive signs or symptoms.