cancer prevention

Cancer can be a scary topic, but one type – cervical cancer – represents a real clinical success story. Over the millennia, we’ve graduated to a fuller understanding of how the immune system figures in this disease, which was once the second most common cancer in women.

The cervix is the bottom part of the uterus – and we’ve known about cervical cancer since Hippocrates first described it in 400 B.C. We’ve also known that this type of cancer has been associated with sexual contact since 1842, when a physician in Italy described a difference in cervical cancer incidence between abstinent nuns and other women. (This was before we knew even what caused the sexual infection.)

Thanks to the development of the Pap smear (for Papanicolaou), the 1950s and 1960s showed a decrease in the incidence of cervical cancer. We still didn’t know what caused the sexually- transmitted infection, but we could screen for pre-cancer stages and treat it before it became cancer. Thanks to this strategy, by 1994 the incidence was down to 8 cervical cancer cases per 100,000 women in the U.S.

And now another huge breakthrough is the identification of HPV (human papilloma virus) types as the major cause of cervical cancer. The viral types were first isolated in the 1980s; we can now screen for HPV types which are responsible for both cervical cancer (called high risk HPV types) and genital warts (called low risk HPV types). Most people with healthy immune systems can fight off the virus within two years. But when the immune system is already compromised, the body has limited ability to fight off infection, and cancer may develop. A lifetime use of condoms will decrease the risk of cervical HPV infection by 70 to 80% but will not affect the risk to infection elsewhere on the body.

Although we know a lot about the life cycle of the HPV virus, we are still isolating more and more types of the virus and understanding where it chooses to infect both men and women. Three vaccines are also available. One is a “bivalent” vaccine that protects against the two most common high risk HPV types. One is a “quadrivalent” vaccine that protects against the two most common high risk HPV types and also protects against two HPV types that are responsible for 90% of external genital warts. A newer vaccine targets nine different HPV types – hoping to expand the effectiveness of the vaccine. The key to success with these vaccines is to administer the doses before sexual activity begins, which is one reason it is recommended for girls and boys ages nine to 26.

In addition, to keep the immune system strong on a daily basis, it’s smart to live a healthy lifestyle, including good nutrition, regular exercise, good sleep patterns and taking nutritional supplements if needed.



Last month I was on a plane that was diverted from my home destination because of a thunderstorm in the area. We had started out right on time and were actually scheduled to be 20 minutes early at the gate. About an hour before landing, the pilot announced that because of the storms we were going to swing around to the west of the airport and we would arrive about 10 minutes late. Thirty minutes later he announced we were going to land in Abilene (about 175 miles west of Dallas) and refuel and wait until the storms cleared.

None of us were part of the decision-making process, but I found myself with two clear thoughts: 1) I was grateful that the pilot was putting the safety of the passengers and crew ahead of an arbitrary time schedule and 2) I was delighted that our area was getting rain since this has been a record-breaking hot and dry season in northern Texas. Don’t get me wrong, my patient husband was sitting at the airport for several hours because of the mixed messages from the internet notification service – and if you’ve traveled in or around DFW airport in the last six months you know that there is a horrific amount of construction at the north entrance to the facility. We gird our loins carefully when we must travel through it!

Thinking about this experience, I mused later about healthcare providers who fill the role of that pilot in the storm. None of my clients are looking to have life-threatening complications or diseases. Certainly no one signed up for cancer or diabetes or irritable bowel syndrome. I listen to people daily who were blind-sided by a test result or a new symptom like a breast mass in their body; my job is to listen and explore root causes. My training uses western medicine and its technology along with my intuition and experience. My eastern medicine training in acupuncture helps me see the patterns of illness and compare them to what I learn about my client’s nature and disposition.

And then I suggest a course and explain why I chose it. Here is where the co-piloting comes in. For example, I can teach breath work as a type of stress management and show what it feels like to be in coherence using HeartMath. The tool is only useful, though, if it’s used and used regularly. Similarly, I can talk about Dr. Weil’s anti-inflammatory diet and hand out a sheet that describes it, or I can suggest an elimination diet that takes out gluten or dairy, but my client has to agree to their role in the strategy. I can’t fly the plane alone! On the other hand, I have hopefully instilled enough trust and engendered enough respect that my suggestions make sense and the course I’ve plotted feels right.

Most of my clients don’t want to fly the plane. They just want to hear why the pilot chose the course (s)he did. And then they know they are part of the action plan.

This is your captain signing off! As always, we know you have a choice when choosing who is piloting your healthcare plane; thank you for your interest and attention…

Until next time, Be Well!

The researchers with the Women’s Health Initiative (WHI) released more findings last week. The study began in 1999 as a joint venture between the National Institute of Health (NIH) and Wyeth pharmaceuticals and enrolled tens of thousands of women. The study was supposed to run for ten years but was stopped in the summer of 2002 because the risks of hormone therapy (in this case Prempro™ for women who had a uterus and Premarin™ for women who did not) outweighed the benefits. The risks included an increased risk of heart disease, blood clots and breast cancer in the women on the hormones. The benefits included a decreased risk of colon cancer and hip fracture.

My ob-gyn office phone rang and rang and rang when these initial findings came out. Prior to the WHI, the use of “hormone replacement therapy” was almost automatic for a peri-menopausal or menopausal woman. After the initial reports, many of my patients chose to discontinue their hormones. Some immediately restarted the hormones because of hot flashes and then gradually weaned off the hormones. Some stayed on the hormones because they felt the quality of their life was better on hormones than off of them.

As a nation, the incidence of hormone use decreased and the incidence of breast cancer has also decreased since the 2002 report came out. (See the graph at the beginning of the post) The latest report from the WHI suggests that breast cancer rates are LOWER on Premarin™ alone versus placebo in the women who had had a hysterectomy. I doubt this report will change hormone use a great deal.

As I said before in my book, the WHI left us with more questions than answers. What if different hormone preparations had been used? (Wyeth co-sponsored the WHI – the reason for the hormone choice) What if rather than a broad-based population we had targeted younger sympotamatic women (the average age of WHI participants was sixty – well after the onset of menopause). What if we screened the population and only treated nonsmokers?

I’m amazed that there were no extensive data gathered on nutrition (other than “low-fat”), life-pacing or stress management as part of the WHI. What’s more, as in most clinical trials that involve taking chemicals into our body, there was no discussion or measurement of our individual differences in metabolizing the same chemicals out of our body. Our genetic uniquenesses are likely to drive this discussion in ten to fifteen years; for now we are all lumped together as if we were identical metabolically. It’s unlikely that we’ll ever had this large a study population to explore these questions.

Here’s my short summary of recommendations regarding hormone: 1) Do you need them? If the perimenopausal years are wreaking havoc on your sleep patterns or your vaginal lubrication, start first with nutritional choices rich in fruits, veggies and whole grains. Ease off of the animal protein, sugar and caffeine. Learn some breath exercises and/or biofeedback techniques and practice them twice a day. Exercise three or four times a week. 2) If these lifestyle changes don’t lighten the severity of your symptoms, use low dose hormones topically (gels, creams, patches, intravaginal rings, etc) that are chemically identical to the hormones you make yourself. These “bio-identical” hormones are on your formulary and purchased through your insurance plans or compounded to a specific prescription by a specialty pharmacy. 3) If you stay on hormones longer than three months, measure your estrogen metabolites and make sure you are removing the hormones safely from your body. You’ll probably need to find functional medicine practitioners to do this.( 4) Reassess your hormone needs yearly and decide if you need to stay on them or if you can wean off of them. Wean slowly. Ask for assistance from your practitioner.

No doubt about it, some women need hormones for the perimenopausal transition. As a culture, however, we don’t always grasp that our nutrition and lifestyle choices affect our hormone levels. The WHI didn’t answer that question!

Note: I am pleased to welcome a guest author on my blog, my favorite scientist who happens to be my life mate. I asked him to discuss the potential concerns with regards to electromagnetic radiation and cell phones and/or wifi. Please welcome his comments and opinions….

Are we bathed in dangerous radiation from Wifi and our cell phones? We place cell phones right next to our heads and brains while they emit electromagnetic radiation. The public airwaves are full of stories about their potential dangers. Dennis Kucinich, a congressman from Cleveland, has called for further studies. Consumer Reports suggests there should be more study of the possible effects. Yet if you talked to a physicist or a physical chemist, you would almost certainly hear a lack of concern. It would likely be couched in terms like, “as far as we know…”or “to the best of our knowledge…” followed by a strong statement that there is nothing to be worried about. In this blog I will state why I do not believe that there is a problem with these radiation sources and that taking special precautions to shield your house or yourself are unnecessary.
To appreciate the argument, you have to have some kind of basic understanding of physics. This is not extremely complicated, but it is not well known to the public. I will explain the arguments in this blog; I suggest you look into science courses if this intrigues you. My own background is a Ph.D. in chemical physics from Harvard University and a thirty year career in optics, both as a professor and in industrial applications.
Let’s start with discussing quantum mechanics. Don’t panic! The concepts are fairly straight-forward. Our understanding here was mostly formulated in the early 20th century. To start, let’s define electromagnetic radiation: this is the transmission, or flow of electromagnetic energy. The initial understanding of electromagnetic radiation was that it was a wave like phenomenon, something vaguely like the waves on the ocean or in any body of water. Electromagnetic waves are defined by their amplitude (size) and by their wavelength (how close the wave peaks are to each other). The spectrum of electromagnetic radiation covers different wavelengths from long waves, radio waves, microwaves, infra red, visible, ultraviolet, x-rays, and gamma rays. This list describes the the order of energy and wavelength over an enormous scale; the most energetic, the gamma rays, are a thousand thousand trillion times higher in energy and shorter in wavelength than the long waves.
But electromagnetic waves are more than just waves in water, and Albert Einstein won the Nobel Prize for describing this difference. He discovered that electromagnetic waves could sometimes best be described as individual quantum particles called photons. And here’s where it gets interesting! We now know that matter, itself, at the atomic and molecular level is quantized. This means that a molecule can exist in specific configurations – described by its rotation, vibration and electron motion. It follows, then that certain wavelengths can be absorbed and cause molecular change. How much energy or what wavelength is necessary to cause a change in state? And is the change in state dangerous or potentially life-threatening?
This is the crucial point. Only a photon with a specific wavelength can be absorbed and increase the energy of these motions. Relatively low-energy microwaves can change the rotation of molecules. A molecule’s vibration can change with a little more energy – usually in the range of the infra-red. And finally, energy in the visible and/or ultraviolet wavelengths can move a molecule’s electron configurations.
The study of biochemistry involves understanding how combinations of molecules like enzymes, proteins, and DNA change their electron configuration and change their function in our bodies. The molecules in the enzymes and proteins and DNA are held together with chemical bonds. Cancer and disease can occur when the chemical bonds are broken and the function of the chemicals change. Microwaves do not have enough energy in each quantum increment, the photon, to break molecular bonds. In contrast, the sun has enough energy in its photons to break bonds, and can cause problems like melanoma and basal cell skin cancer. That is why dermatologists recommend sunscreen. But the danger from cell phones doesn’t make sense in the same way. In general, your cell phone and your Wifi router do not have enough energy intrinsic in each photon to cause any damage. There are exceptions to this, of course. Microwaves absorbed into molecules do not independently cause damage, but large amounts can heat up tissue. So there is cause for concern if you are unfortunate enough to be inside a microwave oven or stand directly in front of a radar dish! In these cases it is both the size of the waves and the intensity of the exposure that is key.
To summarize, is there a danger in Wifi or cell phone radiation? Probably not. Although both emit microwave electromagnetic radiation, my knowledge and experience tells me this is very unlikely and I would have to see several studies showing good evidence to be convinced the effect is real. These studies are difficult to perform because the supposed effects are never large and are easily confused with other factors such as lifestyle and genetic makeup. The fact that there have been several small studies with most showing no real effect, along with my basic understanding of the physics of electromagnetic radiation interacting with matter tells me there is no danger here.

How do you know when there is something wrong with your health? Are you suddenly struck by a doctor’s diagnosis? I get the sense that people plug along on auto-pilot and then suddenly get blind-sided by a lab test or x-ray result.

We recently had the freezer thermostat replaced in our kitchen refrigerator. We noticed that the refrigerator wasn’t as cold as it had been. As I called to find a repair person, I was struck by the not-so-helpful operator on the 800 Amana customer service line. After the model number and serial number questions, there were questions like: “have you stacked the food in front of the fan?” and “did you just buy groceries?” As you can imagine, since this was the week before the Thanksgiving holiday, the answer to both questions was yes. When I assured her that I could tell that this was NOT just the refrigerator coming into balance after a shopping trip, that I could tell the refrigerator was not working correctly, she reluctantly offered an appointment the next day. I was put off by her doubts and reluctant to lose several hundred dollars of food, so I declined the appointment and ultimately found a local person that diagnosed the problem and fixed it the same day.

My point is that our body gives us lots of warning signs and messages. Sometimes the messages are the four cardinal signs of inflammation from the ancient writings of Celsus (30 BCE – 38 AD) with the latin words dolor (pain), calor (heat) rubor (redness) and tumor (swelling) that were augmented by Galen (129 – 200 AD), who added the fifth sign functio laesa (loss of function). And sometimes we just recognize a gradual shift in energy or mood or stamina.

Like any conversation, we don’t know there is an issue unless we listen. Just stop and listen. A quiet room, a comfortable chair or bed and an inner inventory from head to toe…what do you hear? What is different? What has shifted?

And then with whom do you share what you’ve learned? Is it a not-so-helpful professional like the Amana customer service operator? Do they cause you to doubt in your awareness and sense of your own body? Do they have time to listen to what you are saying?

The New York Times reported on Wednesday that the latest data from the Women’s Health Initiative (WHI) showed that hormones “not only increase the risk of breast cancer but also that the disease will be more advanced and deadly.” They are quoting the JAMA article that came out 10/20/10 by Chlebowski RT et al. which was a compilation of longer follow-up on the original group of subjects in the WHI. Later in the Times article, the reporter notes the increased risk is low, but interviews the lead author of the JAMA article, an oncologist who treats breast cancer patients at Harbor-UCLA in Torrance, California who acknowledges that we (as doctors) don’t really know how much or how long women can safely take hormones. The North American Menopause Society responded with this summary: There are 1 to 2 extra deaths from breast cancer per 10,000 women per year. Specifically, for every 10,000 women in the study who were randomized to placebo, there were 1.3 deaths from breast cancer per year. For every 10,000 women randomized to combined hormone therapy, there were 2.6 deaths from breast cancer per year. The WHI found no increase in breast cancer risk with estrogen alone among women who had had a hysterectomy.
Hormone therapy in menopause became commonly prescribed after a book by Robert Wilson called “Feminine Forever” was published (1968, Pocket Books, New York). Dr. Wilson proposed that estrogen would keep women feeling and looking younger and more vital. It was during this time frame that hysterectomy rates peaked in our country and many women had their ovaries removed surgically – sometimes well before menopause. Supporting these women with patentable estrogen-like drugs was proven to help prevent osteoporosis (thinning of the bones) and atherosclerosis (hardening of the arteries). As a medical community, it became the standard of care to offer hormone “replacement” therapy to every perimenopausal and menopausal woman – even if they still had their uterus. Now fast-forward twenty to thirty years and recognize that hysterectomy rates are lower – partly because of improved technology for surveillance (ultrasounds, MRI scans of the pelvis, smaller sampling instruments to biopsy tissue from inside the uterus) and partly because of improved technology for therapies (endometrial ablations that remove or burn the lining of the uterus, and improved surgical techniques that allow smaller incisions for same-day procedures like laparoscopy or hysteroscopy).
When estrogen alone was shown to cause uterine cancer in a small percentage of women, a synthetic progestin was added and shown to “protect” the uterus. More women were on hormones than ever before. New pharmaceutical products were hitting the market one after another and pharmaceutical companies were watching us aging baby boomers with joyful anticipation.
The next chapter of the hormone story begins abruptly with the first publication of the results of the Women’s Health Initiative (WHI) in the summer of 2002. This study has produced lots of data and papers – this weeks study is one of the follow up papers. Over ten thousand women were randomized to receive either Prempro® (a combination of Premarin – a mix of hormones synthesized from the urine of pregnant horses – and medroxy progesterone actetate – a synthetic progestin) if they had a uterus or Premarin® alone if they didn’t. Although death rates were no different between the groups, there was a statistically decreased rate of colon cancer and osteoporosis and an increased rate of breast cancer, blood clots and strokes in the hormone-using group. The study was stopped early because the researchers believed that the risks of Prempro® use out-weighed the benefits. There is still an on-going analysis of the data as we try to understand the issue. It seems that rather than answering questions we’re left with more questions to answer! What if different hormone preparations had been used? What if we had chosen topical application rather than oral hormones? What if rather than a broad-based population we had targeted younger symptomatic women in their late 40’s or early 50’s? What if we screened the population and only treated non-smokers? I’m amazed that there was no extensive data gathered on nutrition, life-pacing or stress management as part of the WHI. What if we compared hormone use to acupuncture, a modality that has been shown to effectively treat hot flashes and sleep disruptions? It’s unlikely that we’ll ever have this large a study population to explore these questions.

I read my expert colleague’s opinions and am left with an empty feeling. I’m convinced a thorough discussion of stress management, psychosocial support and nutrition should precede any and all prescription pad actions. But that’s not the way medicine is prescribed today…