Female Health Issues After Breast Cancer
Arline Kallick: Thank you. Hello everyone. Welcome to the Y-ME ShareRing Network National Teleconference and we’re happy to have you with us this evening. Our call will begin with tonight’s speaker Dr. Elena Kamel. Dr. Kamel is Associate Professor of Clinical Obstetrics and Gynecology at the Feinberg School of Medicine at Northwestern University and founder of one of the first all women’s OB/GYN groups in Chicago. She is a member of the Northern American Menopause Society with certification as a menopause expert and a member of the International Society of Bone, I hope I’m saying this right, Densitometry and a
fellow of the American College of Obstetrics and Gynecology.
Our topic tonight is: “Female Health Issues After Breast Cancer.” This will be followed by a question and answer session and end with small group discussions. We realize with a one-hour teleconference that it is difficult to answer everyone’s questions. If your question does not get presented during the question and answer portion or the group discussion, please remember you may contact the Y-ME Hotline at 800-221-2141. The Hotline is answered by certified peer counselors who are breast cancer survivors, and available 24/7, or simply visit our website at www.y-me.org. When presenting a question to Dr. Kamel, please be courteous to other callers by keeping your question brief and realizing that it is not a private consultation. So we are now ready to begin this evening’s teleconference. I’d like to welcome Dr. Elena Kamel and you may begin.
Dr. Elena Kamel: Tonight we have the opportunity to really look at some very interesting subjects and topics and I’m going to divide our talk into health issues for the postmenopausal women and health issues for the premenopausal women.
What’s currently known is that approximately one in seven women in the United States will be diagnosed with breast cancer during their lifetime. Although the majority of the affected individuals will be postmenopausal, 25% of these cancers will occur in premenopausal women and nearly 7% of the women will be younger than 40 years of age at the time of diagnosis. Historically most women diagnosed with premenopausal breast cancer have already completed their childbearing; therefore, in the past, issues of subsequent fertility were largely ignored and irrelevant. However, during the last quarter century and during the time period that I’ve practiced, more and more women have deferred childbirth for a number of reasons and so we see the mean age of our first birth increase in the 21st Century. As we have a growing number of women giving birth for their first time in their 30 and 40s, we see an increasing number of individuals that are facing the dilemma of whether or not to pursue pregnancy following breast cancer.
What I’d like to do is address the health issues of both age groups because they’re very, very interesting and much has changed. I’m going to start with the postmenopausal women first and try and highlight the issues that one should be having the discussion with one’s either OB/GYN, or internist, or oncologist because we have to take the blinders off after someone’s had breast cancer.
Usually we deal with a treatment with the chemo or the radiation and it seems that many people forget that there’s other…The issues that we think about and that we need to address for ourselves are the following: As women are postmenopausal, whether they’ve have breast cancer or not, they are at risk for bone loss, and certainly having gone through chemo or having ovaries that are no longer function accelerates bone loss. Bone density testing is a very simple way to assess bone health. It’s a test that a woman lies down in a machine, very, very, very low dose radiation and it scans the major bones that can fracture, which is our spine and hip. In particular, the spine in women in the early 60s is the first to have fractures and that’s why we see that as women age they shorten and they develop curvature. Bone density health can be assessed by testing and then your daily lifestyle – exercise, and it seems that exercise is a cure for everything. But regular exercising, walking 30 minutes three to four times a week, and good calcium intake, either by oral supplements or nutrition, very much can help take care of bone density issues. In addition, we have now really seen a growth in medications, the bisphosphonate drugs in particular, that can help improve bone health.
Going to the next issue, colon cancer screening: We know that women who have had breast cancer can also have an increased risk of colon cancer. So it’s a very important that women get their colonoscopy.
Very often what I see as a major complaint is that women are done with their chemo, they’re done with their treatment, and they’re trying to achieve normalcy again in their life and normalcy means sexuality, means having a relationship again with their partner and many a times if they have lack of ovarian function or they’ve been menopausal, they even see a worsening of their vaginal health, meaning dryness or change in sex drive. Those two often go hand-in-hand.
There are many things that we can do to improve vaginal health because having a dry vagina means that intercourse can be painful, uncomfortable; and it’s very rare that someone wants to do something that’s uncomfortable. We have lots of lubricants. There are water-based lubricants. They are glycerin-based lubricants and many people have even started to look at using very, very low dose estrogen components for the vagina because the vagina is an estrogen sensitive organ. It may always be a silly analogy, but it’s true, you often hydrate your face with different kinds of moisturizers, well the vagina needs the same in the menopause. It needs to be rehydrated and it’s best rehydrated with estrogen and there’s some very good work that was done by Lila Nachtigall at NYU looking at using tablets, Vagifem is the product, that has a 25 microgram concentration of estrogen that we put in the vagina twice weekly, very safe, you only get local therapy, local absorption; and people do not get systemic levels, so you don’t get blood levels of estrogen, which is every person’s fear who has breast cancer. That way we’re able to revitalize the vagina and let it be user-friendly.
One of the dramas of the menopause is decrease in sex drive and that is a very complex subject that has in women a multiplexity of factors that contribute to it. But, in particular, when something is not palatable from a point of view of pain and discomfort, it’s certainly not something we want to do. Many women can benefit from either rehydrating the vagina or there are also medications that can help with sex drive. In particular, some women use a medicine called Wellbutrin that can stimulate a little bit extra drive. At this point we really have no other approved products. There are some bioidentical pharmacies that make testosterone products, but those really have not had enough science behind them to encourage women to use. I will say that on the market in testing are some testosterone gels that hopefully may enhance sex drive in the future for women,
Obviously for the postmenopausal women, there may be the issue of hot flashes and that can be exacerbated after treatment; and so, unfortunately, we don’t really look to estrogens to treat that, but there are some non-estrogen containing medications and actually herbs that can help women with flashes. So many people try a medicine called Effexor. There are some of the other family of medicines in the serotonin category like Prozac, Zoloft that can help. There are more non-traditional things like the use of primrose oil capsules, exercise, staying away from wine, spicy foods, stress to try and avoid the complexity of hot flashes.
Then importantly the whole concept of genetic testing and screening comes into play in the menopausal women with breast cancer because we know that women who have the BRCA gene testing are also, if they’re positive, they have the increased risk of ovarian cancer that’s associated with breast cancer. So we strongly encourage as someone makes a health plan for themselves that they don’t forget the other component and that is looking at the ovaries and potentially seeing if one requires ovarian removal. So those are some of the issues that we start off with.
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| Free teleconference and small group discussion
May 21, 2008, 7:00 p.m. (CT) |
Question & Answers
If I had my ovaries removed, does that mean that I can’t get ovarian cancer?
Do hot flashes get worse after breast cancer treatment?
Do you recommend then after breast cancer that the ovaries should be removed?
If I am ER+, what are my options for treating vaginal dryness?
What effect does chemo have on my eggs?
I had breast cancer at 36. When should my daughters start begin to get screenings?
