well women check up & screening

DR. SARITA KAPOOR, M.S.,O B S T E T R I C I A N & G Y N E C O L O G I S T

G E T W E L L M E D I C A L C E N T E R

WELL WOMEN CHECK UP & SCREENING

WOMEN’S HEALTH

Getwell Medical Center - www.getwelluae.com

PREVENTION IS BETTER THAN CURE

• Stop thinking of“ILLNESS” and startthinking of“WELLNESS”.

• Spending few hourswith the Gynaecologistrelieves you from thefear of forthcominggenital or breastproblems.



“There are three reasons for breast feeding:

the milk is always at the right temperature;

it comes in attractive containers;

and the cat can’t get it.”

FEMALE BREAST ANATOMY


THE TOP 5 KILLERS OF WOMEN


Heart Disease

Cancer

Lung Cancer

Colorectal Cancer

Breast Cancer

Stroke

Respiratory Disease

Alzheimer's Disease

Breast Disease

Benign Malignant


Benign Conditions

Fibrocystic breast change

Infections and inflammations

Abnormal nipple conditions

Other breast conditions

• supernumerary breasts• gynecomastia (males)• Paget's disease of the breast• nipple discharge, galactorrhea• breast cyst• mastalgia• galactocoele


BREAST CANCER

• The most common form of cancer among women

• The second most common cause of cancer related mortality

• 1 of 8 women (12.2%)

• One third of women with breast cancer die from breast cancer


RISK FACTORS OF BREAST CANCER

Birth of first child after the age of 30 yrs

Personal history of breast cancer

Early onset menstruation before the age of 12 yrs

Late menopause after 55 yrs

Family history of breast cancer-mother, daughter or sister

Exposure to radiation

Diet high in fat Overweight for elderly women


WARNING SIGNS OF BREAST CANCER


SCREENING TESTS


Mammography

Accuracy of mammograms

The mammography debate

Follow-up after an abnormal mammogram

Clinical breast exam

Follow-up after an abnormal clinical breast exam

Breast MRI

Ultrasound

SCREENING RECOMMENDATIONS


For women at average risk Ages 40-49 Ages 50-69 Ages 70 and older

For women at higher risk Lobular carcinoma in situ (LCIS) Atypical hyperplasia BRCA1 or BRCA2 gene mutation Strong family history Personal history of breast cancer (including DCIS) Dense breast tissue

For men at higher risk due to an inherited gene mutation or strong family history


GUIDELINES FOR BREAST EXAMINATION

BREAST SELF EXAMINATION:

• Monthly beginning at the age of 20 yrs

BREAST EXAMINATION BY A DOCTOR:

• Annually beginning at age 18 yrs.

SCREENING MAMMOGRAPHY:

• Baseline between the ages of 30 and 40 yrs.

• Every 1 to 2 yrs from age 40 to 50.

• Annually after the age of 50.

BREAST SELF EXAMINATION

Learn and practice Breast Self Examination (BSE) regularly. It is easy, convenient and inexpensive!

LOOK and FEEL what is normal for you.For any spontaneous change, see your physician without delay!

Make sure you compliment your BSE with a yearly physical exam of your breasts by a trained professional and ask about risk factors and breast screening.


MAMMOGRAM


BREAST ULTRASOUND


BREAST MRI


GENETIC TESTS

How helpful are BRCA1 and BRCA2 genetic tests in identifying women at risk?

What is the link between estrogen and breast cancer?


PEOPLE AT HIGHER RISK OF BREAST CANCER


BRCA1 and BRCA2

Gene mutations and genetic testing

Options for women at higher risk

More frequent or earlier screening

Preventive surgery

Risk-lowering drugs (tamoxifen and raloxifene)

The use of tamoxifen and raloxifene to reduce the risk of breast cancer

Clinical trials for women at higher risk

YOUR BEST DEFENSE


The best way to find breast cancer early is to get screened. Talk to your health care provider about what screening tests are right for you

A mammogram

A clinical breast exam

BREAST CANCER PREVENTION


Limit Alcohol

Don't smoke

Control your weight

Be physically active

Breast-feed.

Limit dose and duration of hormone therapy

Avoid exposure to radiation and environmental pollution

FOODS THAT PREVENT BREAST CANCER

Flaxseed

Brazil nuts

Garlic

Pomegranate

Dark-green leafy vegetables

Salmon

Broccoli and broccoli sprouts

Green tea

Peppers

Turmeric

Walnuts

Berries

Whole grains

Legumes

Best diet formula

Lead a healthy and disease-resistant life with a diet high in fruits and vegetables, whole grains, lean meat and dairy products.


FAQs


Worried About Lump in Breast

Can Wearing a Bra all the Time Cause Cancer?

Can Benign Cysts Become Cancerous?

Can I Inherit Breast Cancer?

Angelina Jolie Reveals Breast Removal Surgery


Other Screening Test for Women


• Pap Smear• Pelvic Ultrasound Scan• Blood Markers • CA125• CEA• AFP

WHAT IS SCREENING?


Screening is done to diagnose a diseasebefore symptoms occur, when timelytreatment can avert disability andmortality.

REDUCING RISK OF CERVICAL CANCER


•Regular smear test

•Use condoms for contraception (They reduce risk of warts and STD)

•Stop smoking

HP VACCINE CERVICAL CANCER


The HPV vaccines rely upon a 3 dose series,administered over a period of 6 months.Immune theory and available data suggest aprime with the first dose, a boost with thesecond dose, and higher longer term titersfrom the third dose.

HPV VACCINE


The quadrivalent HPVvaccine (Gardasil®,Merck) is approvedfor administration togirls and women ages9 to 26 years as a 3dose series.GlaxoSmithKline filedfor FDA approval ofCervarix™ in March2007.

NUTRITION'S NEWEST STAR

Amazing Vitamin D

Vitamin D: Is it a Wonder Pill?

Vitamin D is an essentialnutrient important for strongbones. In addition vitamin Dcan boost your immune system,support muscle function, keepyour heart healthy, and aid inbrain development. Vitamin Dis produced by the body whenyour skin is exposed tosunlight. It's important to getenough of this vital nutrient soyou don't wind up with avitamin D deficiency.

Vitamin D Boosts Bone Health

Your body needs vitaminD to help absorb thecalcium and phosphorusin your diet that makesfor strong bones. VitaminD deficiency can causerickets in children and acondition calledosteomalacia in adults.Symptoms may includeweakness and bone pain.

Vitamin D and Multiple Sclerosis

Higher blood levels ofvitamin D seem to beassociated with a lowerrisk of developingmultiple sclerosis (MS).

Supplementation withvitamin D may bebeneficial for MSpatients, but the dose isyet to be determined.

Vitamin D and Diabetes

Type 2 diabetes is acondition where the bodydoes not use insulinproperly, and bloodsugar levels can riseabove normal.

Vitamin D and Weight Loss

Obesity is a risk factorfor low vitamin D levels,because the more weightyou carry, the more ofthe vitamin you require.

One small study foundwomen with low levels ofvitamin D might be moreprone to gain weight.

Low "D" and Depression

There may be anassociation between lowlevels of vitamin D anddepression.

Vitamin D itself may notward off depression butin patients who aretaking antidepressants,taking them along withvitamin D may helpreduce symptoms ofdepression.

How Does Sun Give You Vitamin D?

The easiest way to getvitamin D is by exposingyour skin to directsunlight, specifically,ultraviolet B (UVB) rays.The more you expose yourskin, the more vitamin Dyour body produces. Youonly need to spend abouthalf as much time as ittakes to turn pink and getsunburn.

Dining With Vitamin D

Most foods that containvitamin D only containsmall amounts and won'tgive you all your bodyneeds. Foods thatcontain vitamin Dinclude fatty fish such assalmon or mackerel, beefliver, egg yolk, milk ororange juice fortifiedwith vitamin D, fortifiedcereals, and infantformulas.

Begin Your Day With Vitamin D

Many foods typically eaten for breakfast are fortified with vitamin D. Milk, cereal, orange juice, and breads often have added vitamin D. Egg yolks also contain the vitamin. Read labels to find out how much vitamin D is in the food you eat for breakfast.

Vitamin D Supplements

If you don't get enough sun exposure, food is unlikely to give you the amount of vitamin D your body needs. In this case, your doctor may recommend you take vitamin D supplements. There are two forms of vitamin D: D2 (ergocalciferol), found in food, and D3 (cholecalciferol), produced by your body from exposure to sunlight. Most over-the-counter vitamin D supplements contain vitamin D3, which is not usually vegetarian. If you have concerns about this, your doctor may prescribe vitamin D2 supplements.

Are You Vitamin D Deficient?

There are some risk factors for vitamin D deficiency. These include factors you can control such as:

Spending a lot of time indoors during the day.

Covering your skin with clothing or SPF all the time.

Obesity or gastric bypass surgery. Infants who are breastfed and not given

a vitamin D supplement. Living in northern regions where there

are fewer hours of sunlight.

Factors that put you at risk for vitamin D deficiency you cannot control include:

Having darker skin. Being older – your skin is thinner. Pregnancy.

Symptoms of "D" Deficiency

Symptoms of vitamin Ddeficiency may be verygeneral. You might haveaches and pains andfatigue. You may not haveany symptoms at all. Ifyour vitamin D deficiencyis severe, you may sufferform bone pain andreduced mobility. In adults,severe vitamin D deficiencyis called osteomalacia, andin children a severedeficiency can lead torickets.

Testing Your Vitamin D Level

A simple blood test calledthe 25(OH)D test canmeasure levels of vitaminD in the blood. Levels ofthe vitamin aremeasured in nanogramsper milliliter (ng/mL),and the Institute ofMedicine currentlyrecommends 20 ng/mLas an adequate level forbone and overall health.

How Much Vitamin D Do You Need?

The U.S. recommended daily allowance (USRDA) for vitamin D is 600 IU (international units) per day for children age 1 year up to adults of 70 years. Infants under 1 year need 400 IU, while adults 71 and older require 800 IU. Vitamin D in excess of 4,000 IU can cause side effects such as anorexia, excessive urine output, heart arrhythmias, and kidney stones.

Daily "D" for Breast-feeding Babies

The amount of vitamin D inhuman breast milk isminimal. In addition,because infants should bekept from direct sunlightand use sunscreen, theygenerally do not get enoughof this vitamin withoutsupplementation. TheAmerican Academy ofPediatrics (AAP)recommends nursinginfants should receive 400IU of vitamin Dsupplementation per day.

Vitamin D for Older Children

Many children do not getthe recommended amountsof vitamin D in their diet,putting them at risk forvitamin D deficiency andrickets. The AAPrecommends infants 1 yearand under get 400 IU perday of vitamin D, and 600IU daily of vitamin D forchildren and teens. Talk toyour child's pediatricianabout vitamin Dsupplementation and theright amount for yourchild.

How Much Is Too Much Vitamin D?

There is such a thing as toomuch vitamin D. Vitamin D inexcess of 4,000 IU can causeside effects such as anorexia,excessive urine output, heartarrhythmias, and kidneystones. Long-term toxicity cancause damage to the heart,blood vessels, and kidneys.Excess vitamin D is usuallycaused by taking too much inthe form of supplements. It isnot possible to get too muchvitamin D from sun exposure –the body regulates the amountit produces.

Drugs That Interact With Vitamin D

Vitamin D supplements caninteract with several types ofmedications. Steroids can interferewith vitamin D metabolism andaffect calcium absorption. Weightloss drugs including orlistat(Xenical, and Alli) and thecholesterol-lowering drugcholestyramine (Questran,LoCholest, Prevalite) can reduceyour body's absorption of vitaminD and other fat-soluble vitamins.Drugs to control epileptic seizuresphenobarbital and phenytoin(Dilantin) can increase themetabolism of vitamin D andreduce calcium absorption. Statinsand diuretics can increase vitaminD levels. Tell your doctor if youtake any vitamin D supplements.

Vitamin D and Colon Cancer

Some studies have shownvitamin D may affectcancer risk. Moreresearch is needed todetermine if low levels ofvitamin D in the bloodincrease cancer risk, or ifadequatesupplementation ofvitamin D can preventcancer.

Vitamin D and Other Cancers

Research is ongoing on thepossible connection betweencertain cancers and vitamin D.Some think it may help preventcolon, prostate, and breast cancers,but the evidence so far is lackingand it is unknown if vitamin D canprevent cancer, or increase risk.One study even found vitamin Dlevels might increase the risk ofpancreatic cancer. Currently, theVITAL Study at the Brigham andWomen's Hospital, an affiliate ofHarvard University MedicalSchool, is investigating whethertaking vitamin D and omega-3fatty acids reduces the risk fordeveloping cancer, heart disease,and stroke.

Vitamin D and Heart Disease

Low levels of dietaryvitamin D are associatedwith a greater risk forstroke and heart disease.On the flip side, highlevels of vitamin Ddeficiency can causetoxicity and damage theheart, blood vessels, andkidneys. Talk to yourdoctor about the rightamount of vitamin D foryour heath needs.

A Factor in Dementia?

One risk factor for lowerlevels of vitamin D is age.As we age, our skin thins,and we can't produce asmuch vitamin D as we usedto. Low levels of vitamin Dhave been associated withcognitive decline; however,more research is needed todetermine the optimumlevels of vitamin D neededto possibly preventdementia.

Fat-Fighting Foods

Greek Yogurt

What makes Greek yogurt adelicious tool for weightloss is its protein content.It has twice as much asother yogurts. "Proteintakes longer to leave thestomach," says sportsnutritionist Leslie Bonci,MPH, RD. "That keeps yousatisfied longer." As abonus, Bonci tells WebMD,the body burns morecalories digesting proteinthan carbs. Non-fat, low-fat, and low-sugar typeskeep a slim profile.

Quinoa

Quinoa (pronounced keen-wa) is a nutritional all-starthat belongs in your weightloss plan. This whole grainhas 8 grams of hunger-busting protein and 5grams of fiber in one cup,plus it's as easy to cook asrice. It's also packed withnutrients such as iron, zinc,selenium, and vitamin E.For a quick and interestingdinner, mix in somevegetables, nuts, or leanprotein.

Cinnamon

Studies suggest cinnamon may have a stabilizing effect on blood sugar levels. This could curtail appetite, particularly in people with type 2 diabetes, Bonci says. Nearly everyone can benefit from cinnamon in its traditional role. Stir some into your coffee, tea, or yogurt to add sweetness without adding calories.

Hot Peppers

Hot peppers contain aflavorless compound calledcapsaicin. It's moreplentiful in spicyhabaneros, but also occursin jalapeños. Thiscompound appears to curbappetite and speed up themetabolism slightly, butonly for a short time. Boncidoubts that this has asignificant impact onweight loss. But, she says,people tend to eat lesswhen their food is spicy.

Green Tea

Several studies suggest greentea may promote weight lossby stimulating the body toburn abdominal fat. Green teacontains catechins, a type ofphytochemical that maybriefly affect the metabolism.To get the most benefit, youmay need to drink green teaseveral times a day. Boncirecommends taking your teahot, because it takes longer todrink, slowing your calorieintake and providing asoothing, mindful experience.

Grapefruit

While grapefruit doesn'thave any magical fat-burning properties, it canhelp dieters feel full withfewer calories. Bonciattributes this to theplentiful amounts ofsoluble fiber, which takelonger to digest. Havinghalf a grapefruit or a glassof grapefruit juice before ameal may help fill you up,so you eat fewer caloriesduring the meal.

Watermelon

Foods that are high inwater content take up moreroom in the gut, Bonci says.This signals the body thatyou've had enough to eatand leaves less room forother foods. Many rawfruits and vegetables arechock-full of water andnutrients, but low incalories. Watermelon is agreat example. It's a richsource of the antioxidantlycopene and adds somevitamins A and C to yourday, too.

Pears and Apples

Pears and apples are alsohigh in water content. Eatthem with the peels forextra fiber, which will keepyou full longer. Boncirecommends whole fruitsrather than fruit juice. Notonly do you get more fiber,you have to chew the fruits.This takes longer andrequires some exertion.You actually burn a fewcalories chewing, asopposed to gulping down asmoothie.

Grapes vs. Raisins

The value of water contentbecomes clear when youlook at two cups of grapesvs. ¼ cup of raisins. Eitherchoice has a little morethan 100 calories, but thelarger portion of grapes islikely to feel moresatisfying. Still, Bonci says,dried fruit has aninteresting texture. Whenused sparingly, a fewraisins or dried cranberriescan make a salad moreappealing.

Berries

Like other fruits, berriesare high in water and fiber,which can keep you fulllonger. But they haveanother benefit -- they'revery sweet. This meansberries can satisfy yoursweet tooth for a fraction ofthe calories you would takein gobbling cookies orbrownies. Blueberriesstand out because they'reeasy to find and loadedwith antioxidants.

Raw Vegetables

Raw vegetables make anoutstanding snack. Theysatisfy the desire to crunch,they're full of water to helpyou feel full, and they'relow in calories. Half a cupof diced celery has justeight calories. Boncisuggests coating celerywith a little peanut butteror dunking carrots in salsa.When you're in the moodfor chips and dip, tryreplacing the chips withraw veggies.

Sweet Potatoes

Think of the typicaltoppings on your bakedpotato -- butter, sourcream, maybe cheese andbacon bits. If you substitutea sweet potato, you mightnot need any of that. Bakedsweet potatoes are so full offlavor, they require verylittle embellishment. Thiscan save you loads ofcalories. As a bonus, sweetpotatoes are packed withpotassium, beta carotene,vitamin C, and fiber.

Eggs

Studies suggest eating proteinin the morning will keep yourhunger at bay longer thaneating a bagel or other carbs.One egg has only 75 caloriesbut packs 7 grams of high-quality protein, along withother vital nutrients. Bonciadds that your body will burnmore calories digesting eggsthan a carb-heavy breakfast.If you have high cholesterol,check with your doctor abouthow many eggs you can eatper week.

Coffee

It sounds too good to betrue -- one of yourfavorite beverages mayactually help rev themetabolism and help youlose weight. Bonci sayscoffee does stimulate themetabolism -- a little.She cautions that theeffect is small and iseasily cancelled out bythe extra calories in amocha cappuccino.

Oatmeal

Oatmeal has three thingsgoing for it: fiber-richwhole-grain oats, lots ofwater, and it's hot. Boncisays this is a very fillingcombination. Hot foodtakes longer to eat, and allthat liquid and fiber willhelp you feel full longer."Don't buy the one that'salready sweetened," Boncisays. "You can choose howto flavor it." Stirring incinnamon or nutmeg willgive you a sweet taste withless sugar.

Crispbreads

Whole-grain rye crackers,sometimes calledcrispbreads, offer a low-fat,fiber-packed alternative totraditional crackers.Research suggests peoplewho replace refined grainswith whole grains tend tohave less belly fat. Wholegrains also provide a richerassortment of plantnutrients. This doesn't justapply to crackers. You canget the same benefits byswitching to whole-grainbreads, cereals, and pastas.

Tabouli

A standout whole grain isbulgur wheat, the typefound in tabouli. It's highin fiber and protein, butlow in fat and calories. Thathelps you fill up with aminimum of calories. Bonciadds that the rich tastemakes it satisfying. "It'sflavorful, so you don't needto add a lot of oil," she says.To turn this dish into ameal, she suggests addingbeans and stirring in extratomato, cucumber, andparsley.

Soup

Soup -- we're talking broth-based, not creamy -- is adieter's friend in several ways.It's full of water, which fillsyou up with the fewestpossible calories. It's hot,which prevents you fromguzzling it down too quickly.When eaten before a meal,soup can take up space thatmight have gone to highercalorie foods. You can alsomake a satisfying, low-caloriemeal out of soup alone byadding chicken, fish, cut-upvegetables, or beans.

Salad

Another way to fill up before ameal is by eating salad.Lettuce has plenty of watercontent to take up space inthe stomach. That leaves lessroom for fattier foods thatmight come later in the meal.Make your salad interestingby adding a variety of fruitsand vegetables or gratedcheese. But be careful aboutdressing, which can add a lotof calories. Boncirecommends using salsa,hummus, or black bean dip asdressing.

Vinegar

If you dress your salad withoil and vinegar, you mayget another fat-fightingbenefit. More research isneeded, but some studiessuggest vinegar may helpthe body break down fat.Whether or not this effectpans out, Bonci saysvinegar is a good choice.It's full of flavor that canmake salad more satisfying-- and it has no calories.

Nuts

Nuts are an excellent wayto curb hunger betweenmeals. They're high inprotein, fiber, and heart-healthy fats. Studiessuggest nuts can promoteweight loss and improvecholesterol levels wheneaten in moderation. Thekey is to "be careful withquantity," Bonci tellsWebMD. "Choosesomething in a shell, so youhave to work harder andslow down."

Air-Popped Popcorn

Three cups of plain, air-popped popcorn may seemlike a whole lot, but thecalorie content is low. Allthat air adds volumewithout adding fat orsugar. "When people arelooking to snack, they don'tstop at 10 potato chips,"Bonci says. They want tohave their fill, and a bigbowl of popcorn delivers."It's visually satisfying,plus it takes time to eat."

Skim Milk

Skim milk provides plentyof protein and calcium withnone of the fat found inwhole milk. And eventhough it's fat-free, skimmilk can help you feel full.It takes longer to leave thestomach than drinks withless protein, Bonci says.There's also evidence thatskim milk and other nonfatdairy foods may promoteweight loss, particularlyaround the mid-section.More research is needed toconfirm this effect.

Lean Meat

As we've seen, protein cankeep you full longer and burnmore calories duringdigestion. But you want tochoose your protein carefully.Dark meat tends to be high infat, which could cancel outsome of the benefits. Skinlesschicken breast is a greatchoice. And some cuts of beefcan make the grade. Flanksteak, eye of round, and topsirloin are extra-lean with lessthan 4 grams of saturated fatper serving. Just stick with a3- to 4-ounce portion.

Fish

One of the best sources ofprotein is fish. Studiesshow it's more satisfyingthan chicken or beef,probably because of thetype of protein it contains.Most fish is low in fat, andthe exceptions usually havea healthy form of fat --omega-3 fatty acids.Omega-3's, which arefound in salmon, herring,and other fatty fish, appearto help protect againstheart disease and otherchronic conditions.

Beans

Beans deliver a nutritionaltriple punch, Bonci says.They're a vegetable, aprotein, and a great sourceof fiber. This means they'llhelp you stay full for theprice of very few calories.They're also easy to preparewhen the munchies strike.Open a can of garbanzobeans and toss them intosoup or salad or mash themup to use as a dip. One cuppacks 12 grams of fiber,just 4 grams of fat, and 15grams of protein.

“God created womanto tame man.”


well women check up & screening

Health & Medicine

testsgetwell medical

breast problems

breast self examinationlearn

factors of breast cancerbirth

dcisdense breast tissuefor

common form of cancer

olderfor women

screening mammography