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Ellen Dolgen

  • Pelvic Exams--They are A’changin’

    Posted on Monday, October 20, 2014 of you are used to getting a Pap smear during your annual visit to the gynecologist, but now some health authorities are recommending the age-old Pap be replaced by a new test designed to detect cervical cell abnormalities just about the time they start up.

    So, although the Pap test, which has been the gold standard for diagnosing cervical cancer since the 1950's is still around, there might be something new on the horizon. You might be asking yourself, 'why,' since the National Cancer Institute says the Pap, named after Greek doctor Georgios Papanikolaou, has helped reduce certain cervical cancers by up to 80%.

    The NCCC (National Cervical Cancer Coalition) says that cervical cancer is very preventable and in fact can be prevented through early diagnosis and appropriate treatment of certain cells that become abnormal when impacted by the human papillomavirus (HPV); this is a process which begins long before the actual cancer develops. The Pap has been the topline test for HPV, but there are other, perhaps even better, options to spot the troublesome cells in women starting at an earlier age, according to one government agency.

    The FDA has recommended a replacement screen to detect gynecological cancers, suggesting that the Pap is soon to become a thing of the past. Does this mean that the days of lying on your back, scooting your bottom down to the end of the table, putting your feet in stirrups and waiting for the swab might be coming to a close? Not necessarily.

    The "Quiet Virus"

    Physicians have known for some time that there is a critical link between cervical cancer and the human papilloma virus (HPV), which is transmitted via sexual intimacy and has a tendency to hang around like a bad boyfriend.

    HPV is not very common after the age of 30, but if you test positive for this virus, you may have gotten it many years before and your immune system is still showing positive. HPV causes changes at the cellular level only after it's invaded and been in your system for a while. That is why testing after age 30 is beneficial.

    Recently, the FDA issued guidelines indicating the agency is ready to recognize the Roche HPV DNA test as the frontline check for women over the age of 25. According to the FDA, this specialized DNA test provides not only a current snapshot of the health of your cervix, which is located at the bottom of your uterus, but also provides important information about your risk for developing cervical cancer in the future. It works by detecting DNA from 14 high-risk HPV types, identifying HPV 16 and 18, as well as 12 other types of high-risk HPVs. Doctors get the DNA by swabbing your cervix, much like the traditional Pap.

    If you test positive for HPV 16 or 18, the agency recommends a colposcopy, which lights up and magnifies your cervix, so that your doctor can more closely observe what's going on with your cervical cells. If you test positive for one of the other types of HPV, then it's recommended you have a Pap test to determine your need for the colposcopy.

    One study, the ATHENA (Addressing the Need for Advanced HPV Diagnostics) found that taking a random biopsy at the time of the colposcopy was even more effective in detecting cervical cancer, whether there were visible lesions, or not. In other words, the Pap smear might become just a part of, and not the centerpiece of, your annual pelvic exam.

    But Wait—There's More

    Now several groups of physicians believe that bimanual palpation of your uterus and internal organs (when your doctor inserts two fingers and feels around your abdominal area) is not only unnecessary in most cases but also intrusive enough to cause some patients anxiety.

    This past summer, the American College of Physicians (ACP) came out against routine pelvic exams which involve bimanual palpation, but only in women who are not at high risk for certain cancers, such as uterine or ovarian and those who are not pregnant, because the organization says this particular exam is not effective in detecting cervical cancers.

    Those same guidelines do recommend regular exams of the cervix such as Pap smears because the Pap is still very effective in detecting cervical cancer in early stages. However, the actual exam during which your doctor inserts two fingers into your vagina and checks the abdomen is not necessary, with ACP co-author Dr. Linda Humphrey stating specifically that it, "Rarely detects important disease and does not reduce mortality and is associate with discomfort for many women, false positive and negative examinations, and extra cost."

    The ACP, which is the second largest physician group in the country, agreed that the diagnostic accuracy for detecting cancers utilizing this method is very low.

    The American Congress of Gynecology and Obstetrics (ACOG) had a varying viewpoint insisting that women should continue to get annual pelvic exams including bimanual palpitation, but acknowledged that the decision to include all components of the exam rested with both the patient and her physician. ACOG, the leading group of physicians providing healthcare for women, says these 'well-woman visits' are an important part of the patient physician relationship and along with breast exams, immunizations and contraceptive care discussions help nurture that relationship and ensuing trust.

    I chatted with Dr. Rebecca C. Brightman, assistant clinical professor OBGYN and Reproductive Science at the Mount Sinai School of Medicine in New York City, who says, "It is very important for women to realize that the Pap smear is only a portion of the annual gynecologic examination. An annual (and for some patients semiannual) evaluation of a woman's thyroid, breasts and pelvic organs remains essential."

    Dr. Brightman also notes that for some women, their OBGYN might be the one and only healthcare provider. She further explains, "As an OBGYN, we frequently screen for and diagnose other medical conditions. Women confide in their OBGYNs and seek advice in many areas from mental health concerns to social problems. So, it's way more than just a pap smear!"

    Once again, the patient-doctor relationship is so important to a healthier you!

    Which Way Should You Go?

    Like anything else in life, it pays to be informed about your own gynecological health, although it can be difficult to find a blanket one-size-fits-all answer. Some experts say that if you are a woman with an average risk of cervical cancer, then this is the route to follow:

    • Ages 21 to 29: a Pap smear once every 3 years

    • Ages 30 to 65: Pap smear every 3 years or/combination Pap smear and HPV test every 5 years

    • Over age 65: routine Pap screening not needed if recent tests have been normal.

    Bottom line—it's all up to you whether you'll stick with just the Pap or ask for the HPV diagnostics, as well.

    As always, check with your doctor and reach a collaborative decision. It's the best approach to feeling good and staying healthy, all the way through the 'change.

    Suffering in Silence is Out! Reaching Out is In!

    0 Replies
  • HRT and Your Heart Can Be Soulmates

    Posted on Monday, October 13, 2014 is not for weaklings. Dealing with symptoms is at the top of the list, especially with hormones sending you on a wild ride. Hot flashes, insomnia and foggy brain are but a few and just when you make up your mind to explore hormone replacement therapy, you read about possible effects on your heart.

    Many of you know that heart disease is the number-one killer of women in the U.S. and that might have you wondering what impact HRT will have on your own cardiovascular health.

    Like many things in life—it' all about timing.

    Put Your Heart Into It

    In 2010, the National Institute of Health released results of a 15-year study called the Women's Health Initiative, which addressed cardiovascular disease, osteoporosis and cancer as it relates to menopausal women on hormone replacement therapy or HRT.

    That study discovered that replacement hormones might elevate the risks of stroke and heart attacks in older women. However, most of the study's participants were long past the start of menopause, or their last period. Why is that important? Because conversely, women who go on HRT within four years after their last period do not generally suffer negative effects on their cardiovascular system, according by Dr. S. Mitchell Harman, director of the Kronos Longevity Research Institute. He was the lead investigator for the KEEPS (Kronos Early Estrogen Prevention Study) that examined whether starting HRT sooner after the onset of menopause reduces the risks of cardiovascular disease and also whether there is a difference between oral and transdermal application of the hormones.

    Dr. Harman discovered:

    • Neither transdermal nor oral estrogen treatment significantly accelerates or decelerates rate of change of carotid artery intimal medial thickness (CIMT) in healthy recently menopausal women.

    • Both estrogen treatments have some potentially beneficial effects on markers of CVD risk, but these differ depending on the route of estrogen delivery with improvements in LDL and HDL cholesterol seen with oral and reduced insulin resistance with transdermal.

    • No significant effects were observed on rate of accumulation of coronary artery calcium.

    • Women reported significant relief of vasomotor hot flash symptoms with either form of estrogen

     Dr. Harman stated post-study that, "Four years of estrogen treatment in healthy recently menopausal women is unlikely to worsen risk of cardiovascular events and is therefore a relatively safe strategy for relief of menopausal symptoms."

    Different Points of View

    Dr. Joseph Raffaele, former assistant president of medicine at Dartmouth Medical School and co-founder of the PhysioAge Medical Group, believes KEEPS is a good start, but that much more research is in order. He points out that just a tiny percentage of the women in the study had any significant coronary calcium at all: 85% of the women had a coronary calcium score of 'zero.' The 15% who did have calcium buildup showed an improvement with both the estrogen and estradiol treatments.

    "The problem with the WHI study was that its 16,000 subjects were on average too old and too unhealthy to provide meaningful answers to women considering hormone replacement as they enter menopause," says Dr. Raffaele in a recent blog.

    "The problem with KEEPS was the opposite: its subjects were on the whole too young and too healthy (to show significant improvement), especially for a study that only lasted four years. The researchers should have either used a broader cross-section of subjects or made the study much longer to measure how hormone replacement affects measures of atherosclerosis."

    "KEEPS was not worthless," says Dr. Raffaele, "The news of the announcement focused on the positives: that hormone replacement safely improves menopausal symptoms including hot flashes and night sweats, depression, diminished libido and bone density."

    "That's reassuring to women and should help continue to reverse the decade-long misinterpretation of the WHI data that led many physicians to advise against HRT."

    However, Dr. Raffaele says additional research should include a base of at least 5,000 subjects of varying ages and baseline cardiovascular health, and that those women should be followed for 10 years.

    This opinion is echoed by Dr. Josh Trutt who says, "In the WHI trial, the women were NOT recently menopausal and were at relatively higher cardiovascular risk: on average 62.5 years old and either overweight or with high blood pressure. The women in KEEPS are a decade younger and overall healthier, and on estrogen for a shorter time period. It would have taken a very powerful effect to show a benefit in this group."

    Dr. Raffaele points out that just a week after being disappointed by the KEEPS trial report, a new Danish study demonstrated very positive results for recently menopausal women who went on long term HRT. The study appeared in the British Medical Journal. He further explained that in healthy women (such as KEEPS studied) you need to follow them for a longer period of time to show benefit. The Danish study followed them for over ten years. This is key to answering the question KEEPS couldn't answer: Does taking HRT in early menopause decrease the likelihood of developing cardiovascular disease? The answer is a resounding 'yes.' These Danish women had over a 50 percent reduction in combined heart attacks, heart failure and death. Remarkably this reduction started to accrue very soon after initiation of therapy. The cardiovascular benefit occurred without any increase in cancers of any type, including breast cancer for which there was a non-significant reduction in comparison to placebo. Nor was there a significant increase in blood clots or pulmonary emboli."

    However, Dr. Raffaele does point out that the study used 2 mg of oral estradiol, a relatively high dose, and a progestin that is not commonly used in the US for HRT. This study didn't compare different types of estrogens or routes of delivery: for example, whether transdermal estradiol instead of oral, or micronized progesterone instead of norethisterone acetate, would have had better or worse effects on cardiovascular disease or cancer.

    After My Own Heart...

    Where does that leave you? Consider your options; discuss HRT with your menopause specialist taking into account your own personal health background. This will help you and your specialist weigh the risks and benefits to fit your personal needs.

    With a family history of heart disease, I went on bioidentical HRT early in my menopausal journey. My sleepless nights and brain fog went away in a hot flash! My vaginal dryness and crashing libido resolved. All the numbers in my Lipid Panel are normal and my calcium deposit score is 0. HRT restored my feeling of well-being and I know in my heart of hearts that this was just what I needed to do!

    Suffering in Silence is Out! Reaching Out is In!

    0 Replies
  • Breast Intentions in Menopause: Mammogram Guidelines

    Posted on Monday, October 6, 2014 Waldo Emerson once said, 'the only way to have a friend is to be one. ' This time of life, as you transition through menopause, that it becomes equally important to look out for your very own self—especially when it comes to taking care of your health.

    Most of you probably go for annual mammograms, but currently the experts disagree as to when and how often you should take pictures of your 'breast friends.'

    The American Cancer Society (ACS); the National Comprehensive Cancer Network (NCCN) and the US Preventive Services Taskforce (USPSTF) have issued varying guidelines on mammography screening, so I sought clarification from Dr. Anees Chagpar, Associate Professor of Surgery (Oncology) and Director of The Breast Center at Smilow Cancer Hospital at Yale-New Haven.

    Her generous expertise will help us take care of our friends in need that have served us well through puberty, breastfeeding and let's face it—first base.

    First Date

    This year alone, nearly a quarter of a million new cases of invasive breast cancer will be diagnosed. It is estimated that 40% of diagnosed breast cancers are detected by women who feel a lump through self-exams.

    Many of you received your first pink rose at the breast cancer screening facility around age 40. This is because before the age of 40, women's breasts are often too dense to see through. In addition, breast cancer is rare in women under 40 so exposure to radiation at a young age is not warranted. This turning-point magic age of 40 is something the ACS and NCCN still recommend, although the USPSTF does not:

    The USPSTF recommends against routine screening mammography in women aged 40-49. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take into account patient context including the patient's values regarding specific benefits and harms. Grade: C recommendation (*There is moderate certainty that the net benefit for women under 50 is small.)

    "Personally, I advocate annual screening starting at age 40, but tailor this recommendation to individual patients," says Dr. Chagpar. She further points out that women under 40 need not get a mammogram – unless they have a strong family history of breast cancer being diagnosed at an early age; in which case she recommends that women should have a baseline mammogram 10 years before the earliest diagnosis of breast cancer in their family.

    Getting to Know You

    How many of you conduct your own breast self-exam? Dr. Chagpar says there is limited data from large randomized controlled trials on whether the self-exam results in improvements in survival. However, Dr. Chagpar feels that if you're comfortable with doing a self-exam, it is a good way to get to know your body so that you can apprise your doctor of any changes, lumps or abnormalities.

    "Women should also be cognizant about their breast cancer risk, and clinical breast exams should be part of women's annual physical. If a women or her doctor feel a lump, note a suspicious skin change, or see bloody nipple discharge, further workup is warranted, regardless of the patient's age. The reason why some doctors don't recommended self-exam is that, for some women, it increases anxiety and they might be unsure if they are "doing it right" or if what they feel is something to be concerned about."

    Middle of the Roaders

    For those beyond the age of 49, the USPSTF recommends only biennial, not annual, screening mammography.

    Dr. Chagpar believes there are several good reasons to continue annual screenings.

    "There have been a number of randomized controlled trials that have shown the benefit of mammography – the majority of these have been with biennial screening in women 50-74 (although some also excluded women over the age of 70). Hence, the USPSTF's recommendations. However, there is also a plethora of data that women under the age of 50 (particularly in their 40s) also get breast cancer, and may benefit from early detection with mammography. Furthermore, there are interval cancers that may arise between biennial screenings, and hence, the American Cancer Society recommends annual mammography starting at age 40."

    So, why don't all three organizations agree on guidelines?

    "The data are accurate – it's the interpretation of the data, and the formulation of the guideline that varies. There isn't just variation between the USPSTF and the ACS – there is global variation as well. In Canada and the UK, for example, recommendations are for mammography every 2 years starting at age 50," finishes Dr. Chagpar.

    Additional Tests

    The American Cancer Society recommends regular breast MRIs, in addition to mammograms for women over 40 at high risk for breast cancer and as a possible follow-up for abnormalities found by mammograms. The New England Journal of Medicine published studies that concluded MRIs are more effective than simple mammography for women at high risk.

    Dr. Chagpar concurs with these findings. "Women who have a BRCA 1 or 2 gene mutation, women who have not undergone genetic testing but who have a first degree family history of such a mutation, or women who have a lifetime risk of 20-25% based on BRCAPRO or similar models may opt to have annual MRI as there are data that in this high risk population, MRI may be of benefit. MRI is not routinely recommended after a mammogram but may be useful as an adjunct, and may also be useful in particular situations: for example, to look for a primary breast cancer in patients presenting with a metastatic lymph node with a normal mammogram, or patients who have implants in whom there is suspicion of a leak."

    They Can See Right Through You

    I asked Dr. Chagpar to tell us about the new breast tomosynthesis mammography that finds 41% more invasive cancers according to two large, retrospective studies published in The Journal of Roentgenolgy (AJR) and The Journal of the American Medical Association. (JAMA).

    "This is simply a means for mammography to take serial thin slices through the breast tissue rather than a cumulative picture...kind of like slicing a loaf of bread into thin slices and looking at each slice rather than trying to see through the whole loaf. This technique has been shown to reduce the number of call-backs for abnormal screening mammograms and may be helpful in women with dense breast tissue," explains Dr. Chagpar.

    In fact, the doctor says that many centers are actually replacing traditional mammography with tomosynthesis for this very reason, and while insurance companies may not have a separate code for the new technology, it is usually reimbursed at the rate of mammography. She suggests asking your own facility if they offer the procedure and whether your insurance will cover it.

    Continuing the Relationship

    There is much conversation in the media these days about the costs of cancer prevention and whether or not we are "over diagnosing." I am a firm believer that knowledge is power. When I asked Dr. Chagpar what the right age is to discontinue annual mammography, she responded, "What is your general health like? If you are 65, but have heart failure and cirrhosis such that you would choose not to treat a breast cancer if found on a screening mammogram, there is no reason to get the test. However, if you are 79 and run a mile every day, play tennis on the weekends and anticipate significant longevity, you may want to detect and treat any cancer early and should therefore continue to get mammograms until such time you wouldn't."

    You Have the Power

    The American Cancer Society recommends 150 minutes of physical activity per week to keep those free radicals in line.

    Researchers estimate that cancer may be reduced by 9% simply by changing our diets and most studies point to fat as a solid D-lister when it comes to breast cancer.

    And, because I know you're wondering...chocolate and alcohol could be helpful or harmful, depending on whether you indulge a little...or a lot.

    Breast Intentions

    So, in addition to paying attention to your body and knowing your family health history, be proactive when it comes to your breast health. Making informed decisions now is critical, because taking care of the younger you will have the older you healthier and happier.

    It's the breast thing you can do!

    Suffering in Silence is Out! Reaching Out is In!

    0 Replies
  • Grin and Bare It: Put an End to Painful Sex During Menopause

    Posted on Monday, September 29, 2014"Not tonight dear. I have a painful vagina." Say what? If you're making excuses to avoid sexual intimacy with your partner due to vaginal pain, you owe it to yourself (and your partner) to treat it.

    "The big O" does not mean "the big Ouch." Recapture the rapture in bed.

    Pain during intercourse is called dyspareunia (Say what?). If you're experiencing pain during sex, you could be suffering from vaginal atrophy (VA). Vaginal atrophy is a thinning and inflammation of the vaginal wall. VA occurs when estrogen levels drop. Estrogens, produced by the ovaries, maintain the structure and function of the vaginal wall, elasticity of the tissues around the vagina, and production of vaginal fluid.

    Unfortunately, like the rest of your menopausal body, your vagina is aging too.

    Hot flashes, sleeplessness, memory loss and weight gain get top billing when it comes to menopausal symptoms. But vaginal discomfort is every bit as difficult and critical to deal with as those symptoms. Vaginal symptoms can negatively impact not only on your relationships and sexuality, but can affect your quality of life and self-image.

    If you're experiencing these symptoms, you could have VA:

    • vaginal dryness

    • sex-induced pain or bleeding

    • itching

    • soreness or irritation

    • painful or burning urination

    • incontinence (involuntary urination)

    • pain when touching the vagina

    You're not alone. Vaginal dryness affects as many as 75 percent of postmenopausal women. Between 17 and 45 percent of postmenopausal women say they find sex painful, according to The North American Menopause Society (NAMS).

    According to the Women's Health Concern, only 25 percent of these women seek treatment. What's more, according to the International Menopause Society, 70 percent of women say their healthcare providers rarely or never raise the subject with them.

    The Closer survey revealed that vaginal discomfort caused 58 percent of the North American women who were surveyed to avoid intimacy and 64 percent to experience a loss of libido.

    Pain during sex (or simply the fear of pain during sex) can trigger performance anxiety or arousal problems in some women, according to the NAMS. This also can cause dryness or involuntary — and painful — tightening of the vaginal muscles, called vaginismus. It's a Catch-22.

    What's are your options?

    • Pelvic floor therapy. According to Harvard Medical School, this is a relatively new — yet safe and effective — technique. A physical therapist uses massage and gentle pressure to relax and stretch tightened tissues in the pelvic area. You also learn exercises to help strengthen your pelvic floor muscles, which may have been weakened by aging, childbirth or hormonal changes.

    • Personal lubricant or moisturizer. However, your vagina may need more than a lube job. Non-hormonal vaginal lubricantscan help decrease friction and discomfort during intercourse. Be sure that they are water-based and designed for vaginal use. Petroleum-based lubricants can harbor bacteria in the vagina and lead to infection, as well damage latex condoms.

      Vaginal moisturizers (similar to moisturizing your face (most women find these helpful to use every day) can help relieve dryness and rebalance the acidity of the vagina. Both lubricants and moisturizers provide temporary relief of symptoms but do not treat the underlying condition of vaginal atrophy.

    • A menopause specialist. If you're lubed to the max and still have no relief, seek help. If you don't have a menopause specialist, check out my Menopause Doctor Directory.

    • Pelvic examand Pap test. Also have your vaginal secretions and the acid level in your vagina checked. You may need to provide a urine sample if you're experiencing unusual urgency or a leaky bladder.

    • Hormone treatment. Options include local estrogen therapy (LET) and systemic estrogen therapy. LET is estrogen applied directly to vaginal tissues, so it goes directly to the affected area, with minimal absorption of estrogen into the bloodstream. LET is available in creams, a ring and a tablet. Systemic hormone therapy (HT) allows estrogen to circulate throughout the bloodstream to all parts of the body. It's available in many forms: a pill, injection, patch, gel and spray. Systemic HT is most often prescribed for multiple whole-body symptoms of menopause, including night sweats, hot flashes, and others. Some women need a combination of treatments.

    • Talk with your partner. Honesty is definitely the best policy. If you're avoiding sex due to pain, your partner could misinterpret it as your dissatisfaction with the relationship (or the sex).

    I can't believe it's been about a decade since my vagina first committed mutiny and my libido went AWOL. I've since vanquished my vagina problems and located my libido. You can, too. Get your symptoms treated, and you can put the va-va-voom back in your vagina.

    Suffering in silence is OUT! Reaching out is IN!

    0 Replies
  • Ovarian Cancer Awareness Month: Latest Treatment Options

    Posted on Monday, September 22, 2014 you know that September is Ovarian Cancer Awareness Month? Ovarian cancer strikes about 3 percent of women.

    The American Cancer Society estimates that in 2014 about 21,980 women will receive a new diagnosis of ovarian cancer and approximately 14,270 women will die from ovarian cancer.

    Although early cancers of the ovaries generally cause no symptoms, they list the most common signs and symptoms as:

    • Bloating

    • Pelvic or abdominal pain

    • Trouble eating or feeling full quickly

    • Urinary symptoms such as urgency (always feeling like you have to go) or frequency (having to go often)

    Remember, be your own advocate for your health and pay attention to your body. You need to know what's normal for you. If you are concerned, contact your medical professional.

    To learn more about this disease and the possible treatment options, I reached out to Dr. Laura Shawver, an ovarian cancer survivor (and ironically a cancer researcher) and the founder of The Clearity Foundation. According to Shawver, the treatment has remained virtually the same for many years and all women are treated alike in spite of what has become known about the molecular make up of cancers. The Clearity Foundation is working hard to change this. The foundation notes that, like all cancers, ovarian cancer is not a single disease, but a category of many diseases. What these diseases have in common is that they start in the ovaries or in the finger-like opening of the fallopian tube. But just as each woman who develops ovarian cancer is a unique individual; her cancer is unique as well. The foundation's goal is to help women with recurrent ovarian cancer live longer, healthier lives by enabling a more individualized approach to therapy selection.

    • The cause of most ovarian cancer is unknown.

    • Ovarian cancer usually occurs in women over age 50, but it can also affect younger women.

    • Ovarian cancer is the ninthmost common type of cancer in women but the fifth leading cause of cancer death.

    • One of the primary challenges of ovarian cancer is that initial symptoms are generally mild, making early detection difficult. As a result, women often do not notice the symptoms or mention them to their physician until the disease is in advanced stages. Only 24 percent of ovarian cancers are detected at an early stage before it has spread outside the ovaries.

    According to Mayo Clinic, there are three different types of ovarian cancer based on the cell of origin but many, many more based on the genomic underpinnings that drive the cancer to grow and spread. The cell of origin categories are:

    • Epithelial tumors - These tumors begin in the thin layer of tissue that covers the outside of the ovaries. It is estimated that roughly 90 percent of ovarian cancers are epithelial tumors.

    • Stromal tumors - These begin in the ovarian tissue that contains hormone-producing cells and are usually diagnosed at an earlier stage than other ovarian tumors. Approximately, 7 percent of ovarian tumors are stromal.

    • Germ cell tumors - These tumors begin in the egg-producing cells. These are rare and tend to occur in younger women.

    "As soon as I was told I had ovarian cancer," Shawver said, "I wanted to understand the blueprint of my cancer (genomic make-up or molecular profile) so I could match my cancer to a drug that would work best for me. As a cancer researcher, I thought I would have an 'in'! I even remarked to others when I had my diagnosis, 'Oh, I will just have my tumor profiled.' I was so surprised that not only was there no labs that would profile my tumor; there was no mechanism to get this done outside of a clinical trial. This service was not something that existed for ovarian cancer patients. I wanted to change that."

    She launched the Clearity Foundation in 2008 to help ovarian cancer patients and their physicians make better-informed treatment decisions based on the molecular profile of the tumor, which she calls the "tumor blueprint."

    "A tumor blueprint is a means to help prioritize your treatment options," she said. "In newly diagnosed ovarian cancer, everyone gets the same treatment: a combination of two chemotherapy drugs. Unfortunately, 75 percent of ovarian cancer is diagnosed in late stage and 75 percent recurs. These are horrible statistics. When it recurs, doctors have a choice of several agents and then there are clinical trials to choose from, too. A tumor blueprint provides some rationality to the choices rather than pick-out-of-the-hat treatment."

    I noted that on her site one article said that only 25 percent of women who receive chemo will benefit from it. If you ask me, those aren't very good odds. She agreed with me that these are horrible odds.

    "What is more horrible, however," she said, "is that oftentimes women with recurrent disease go from treatment to treatment to treatment all the time suffering through the side effects and often without much benefit. In short, they never get their life back. That's why we are focused on helping them find a drug — either FDA approved for ovarian cancer, FDA approved for another type of cancer, or a drug that is in clinical trials that might have a greater chance of success — and we are the only foundation that provides women access to molecular profiling to facilitate this."

    Dr. Shawver said Clearity navigates the waters to get a tumor specimen to the labs and coordinates the testing. "We consolidate the results from the different labs into an easy-to-read report for the physician. We speak with the patient about her results. We follow each woman to see what her doctor ultimately prescribed (was it based on the test results or something else?) and how she fairs. Clearity acts as both a back office for the doctor but, more importantly as a strong advocate for the patient to provide her and her physician additional treatment options when often there appear to be none. At Clearity, our mission is focused on women with ovarian cancer 'in the fight' where it is too late for early detection and they can't wait for cures for the future. No other organization does this."

    As we know, pharmaceuticals are a business. I was curious as to how realistic/financially feasible it is for drug companies to provide personalized treatment of tumors. She answered me quite frankly: "For the cancers that are common — like breast, lung, prostate and colon — it is much easier for drug companies to provide drugs that match to subsets of patients based on tumor profiling or blueprints. The subsets are large enough to make it economically feasible. However, for ovarian cancer, which is one-tenth or less of the size of the larger tumor types, it is a huge barrier for pharma to choose ovarian cancer as an indication for clinical trials and registration of their drugs."

    "There have not been any dramatic changes in survival rates from ovarian cancer since Taxol® was approved in 1992 in combination with carboplatin. There has been zero success in identifying which women will be cured (25 percent) and zero molecular-targeted agents have been approved for ovarian cancer as there have been for breast, lung, colon, prostate and skin cancer."

    Shawver is hopeful that this will change, but she stresses that we need everyone's help; we need more pharma companies to have clinical trials in ovarian cancer, we need doctors to explore all options for their patients, we need insurance companies to cover the cost of the profiling and we need women to empower themselves with information so that they can best fight their battle. She fully expects that more women will get their cure as we are better able to match patients with treatments.

    The sisterhood is powerful. When we speak out, we shake things up! Look at the strides we have made with Breast Cancer Awareness. When Dr. Shawver was diagnosed with ovarian cancer, she not only took care of herself, but she created a foundation to help others! It is important to note that The Clearity Foundation does not charge for the tumor blueprint.

    However, the foundation does incur significant costs for the services it provides. In addition, it tries to help defray the cost of biomarker testing for women who need financial assistance. The foundation relies on charitable donations to make that possible. In honor of Ovarian Cancer Awareness Month, I shall be making a donation to The Clearity Foundation as a thank you for championing this tremendously important work.

    Perhaps you can find a way to involve yourself in expanding ovarian cancer awareness to help support and advance this cause.

    Together we CAN make a difference.

    Suffering in silence is OUT! Reaching out is IN!

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  • Best Birthday Gift You’ll Ever Receive: Self-Compassion

    Posted on Monday, September 15, 2014 you're in perimenopause, menopause or are postmenopausal like me, one thing is certain: things are not at all like they used to be.

    Hot flashes, anxiety and sleepless nights are part of the package and I'm the first to admit it can be hard to handle. That's why as I turn 61 this month I'm giving myself the gift of self-compassion. After all, living a joyful life and by extension being kind to others depends upon how kind you are to yourself.

    Part of this new normal of being postmenopausal is that I've learned to pay closer attention to my own needs. Traveling down this road through the jungle of menopause, I've adapted by becoming more self-reliant, making me feel more fulfilled. That's very different from how the menstruation journey began years ago.

    A friend of mine swears that the Miss Deb booklet left on her bed by her mother was the best dollar her mom ever spent! It was a pamphlet for 'little girls who would mature soon and pretty much took the onus off her mother having the 'birds and the bees' talk.

    Perimenopause, menopause and postmenopause are far more difficult to comprehend, and even Miss Deb wouldn't be able to explain their ins and outs in a small pamphlet. One thing is for sure—charting your own destiny can be extremely liberating providing you first lighten up—on yourself! Have some self-compassion.

    Be All You Can Be

    This simple slogan used in U.S. Army commercials for 21 years inspired a generation to seek its full potential.

    Menopause triggered that same desire in me—to be the best I can be—right now! Meaning, you can either shrink away into nothing or decide that you're still young enough to remain relevant. Hmmm...decisions, decisions!

    Adversity can only keep you down if you let it or as Henry Ford put it, "When everything seems to be going against you, remember that the airplane takes off against the wind, not with it."

    Make the decision to live a purposeful life using the tools you own now and not the ones from 30 years ago. The only constant in life is change.

    My own purposeful life led me to a wonderful project called, Notes to Our Sons and Daughters: A Celebration of Wisdom. In this I shared my own menopausal transition. I found out above all else, that changing adversity into strength begins within me.

    Embrace Who and What You Are

    Embracing who you are without fear of judgment or rejection is a beautiful side effect of the change. One scientific study found women wait until elder years to let go of, "I've got to look and be perfect," self-talk. Why not start a little sooner? After all, is how you look in a swimsuit really that critical? Ease up—especially on yourself.

    It's OK to Be Vulnerable

    My best approach to embracing vulnerability was to bring menopause out in the open, and that in turn opened all kinds of doors to new opportunities. It was the foundation of my own slogan: "Suffering in silence is OUT! Reaching out is In!"

    Bottling up your emotions is dangerous but sharing this menopausal experience with others will surely affect someone else and might even change their life. Now, that's powerful!

    When Things Aren't OK, You Don't Have to Hide It

    It was incredibly liberating for me to realize that after years of 'soldiering through,' caring for kids, aging parents, house and career, that I could actually say out loud, "Everything is not always ok," without worrying about sounding like I was whining.

    Suppressing emotion has a powerful negative effect on your body called oxidative stress. Free radicals form when you're anxious or stressed out. If you combine those free radicals with hormonal deficiencies, then low-density lipoproteins, for which you need anti-oxidants to fight at the cellular level, are diminished.

    Caregivers, Not Care Receivers

    Try devoting as much time to the woman in the mirror as you do to everybody else. Studies show that society expects women to do the majority of caregiving--there's a surprise. AARP actually did the math and found that collective caregiving is worth more than $450B a year. So, it stands to reason that if it's worth that much to society, then so my dear, you are worth the effort, as well!

    New research says being kinder to you at the very least helps suppress hot flashes, which might be triggered by stressful situations. This seems to be a gender-related psychological marker as according to the study, "Women typically have lower self-compassion than men. Our research indicates that midlife women may benefit from including themselves in the circle of compassion."

    Do Well By Doing Good

    Giving to others is an admirable quality, but that starts with treating yourself with a healthy dose of kindness.

    Self-compassion starts within, so I've decided my best birthday gift this year won't be in bright shiny paper. Instead, I'm making a promise to myself to practice self-acceptance and self-love before ever walking out my front door to help others.

    And, you know what? I feel better already. I like the new me and now I'm ready to live the rest of my life with a wink and a smile.

    I really do deserve a break today!

    Suffering in Silence is Out! Reaching Out is In!

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