Thursday, October 20, 2016

Risk Factors for Breast Cancer

A risk factor is anything that affects your chance of getting a disease such as cancer.  Some of these risk factors can be modified, while some can't be changed. For example, even though breast cancer does occur in males, being a woman is its biggest risk factor since breast cancer is about 100 times more common in females than males. Likewise, growing older is inevitable, but age is also a factor in the development of breast cancer. The older a person is, the more likely she/he is to get breast cancer. Race, too plays a role in breast cancer risk.  White women are slightly more likely to develop breast cancer than African-American women, however, African-American women who develop breast cancer are more likely to die from this disease.

Other breast cancer risk factors that can't be changed are:
  • Increased breast density on mammogram----High breast density means there is a greater amount of breast and connective tissue compared to fat. Women with high breast density are four to five times more likely to get breast cancer than women with low breast density. 
  • Family history of breast, ovarian, or prostate cancer--- A woman who has a first degree relative (parent, brother, sister, or child) with breast cancer has almost twice the risk of a woman without this family history.  This increased risk is thought to be due to genetic factors or having similar lifestyle habits. A history of prostate cancer in a father or brother may also slightly increase a woman's risk of breast cancer.
  • Inherited Gene Mutations---The best known of these mutations affects the genes, BRCA 1 and BRCA 2, which account for 5-10% of all breast cancers diagnosed in the U.S.
  • Exposure to large amounts of radiation early in life--- This could have occurred, for example, with radiation treatment to the chest during the treatment for Hodgkin's disease.   Studies have shown that this increases the risk of developing breast cancer by 3 to 7 times as compared to young women with Hodgkin's disease who did not receive radiation therapy.
  • A personal history of invasive breast cancer or ductal carcinoma in situ (DCIS) ---Women who have had invasive breast cancer have a higher risk of developing a second breast cancer.  This applies also to women who have had a type of cancer known as ductal carcinoma in situ (DCIS). This type of cancer starts inside the milk ducts but hasn't spread into normal surrounding breast tissue. 
The following are the current screening recommendations from the American Cancer Society for women who are of average risk for developing breast cancer:
  1. Women with an average risk of breast cancer – most women – should begin yearly mammograms at age 45.
  2. Women should be able to start the screening as early as age 40, if they want to. It's a good idea to start talking to your health care provider at age 40 about when you should begin screening.
  3. At age 55, women should have mammograms every other year – though women who want to keep having yearly mammograms should be able to do so.
  4. Regular mammograms should continue for as long as a woman is in good health.
  5. Breast exams, either from a medical provider or self-exams, are no longer recommended.
Having any of the non-modifiable risk factors discussed previously increases a woman's risk for developing cancer and requires that screening efforts start earlier, occur more often, or include measures beyond those for women at average risk.  The primary purpose of today's Health Tip is to raise the awareness of women at higher risk and encourage them to discuss appropriate screening for breast cancer with their doctors.

Next week, we'll look at risk factors that can be modified to reduce the risk of developing breast cancer.

Sources for article:
Breast Cancer Prevention and Early Detection from the American Cancer Society
What Affects Your Chances of Getting Breast Cancer from Susan G. Komen

Thursday, October 13, 2016

The ABC's of Viral Hepatitis

"Hepatitis" means inflammation of the liver.  Toxins, certain medications, heavy alcohol use, as well as bacterial and viral infections can all cause hepatitis. The most common types of viral hepatitis are Hepatitis A, Hepatitis B, and Hepatitis C, each caused by a different virus. These viruses may produce similar symptoms (yellowing of the skin and eyes, fatigue, abdominal pain, nausea, vomiting, loss of appetite, and low grade fever) but certain types can be much more serious than others.

 Hepatitis A is spread primarily through food or water that has been contaminated by stool from an infected person. Eating food prepared by someone with Hepatitis A who did not wash their hands after using the bathroom, or not washing your hands after changing a diaper, are possible means of transmission. Rarely, it can be spread through contact with infected blood. Those who are at most risk include international travelers, children in daycare and daycare workers, people living with someone infected with hepatitis, and users of illicit drugs. Hepatitis A usually causes a flu-like illness.  There is no specific treatment for Hepatitis A since it typically resolves on its own in a few weeks and does not progress to become a chronic infection.

The Centers for Disease Control (CDC) recommends that all children between 12 and 23 months of age receive a vaccine to prevent Hepatitis A. Two injections are required, given at least 6 months apart. Adults who are at high risk for infection should also consider receiving the vaccine. Avoiding tap water when traveling internationally and practicing good hygiene and sanitation are other ways to avoid contracting hepatitis A.

Hepatitis B is usually spread when blood, semen, or another body fluid from a person infected with the virus enters the body of someone who is not infected. People most likely to get hepatitis B include those who live with or have sexual contact with an infected person, injection drug users, infants born to infected mothers, health care workers, hemodialysis patients, people who received a blood transfusion prior to 1987 (when better screening began), and international travelers. It can cause a flu-like illness or, on occasion, there may be no symptoms at all.  A blood test is required to confirm that someone is infected with Hepatitis B. In adults, acute Hepatitis B is generally not treated with antiviral drugs because the disease usually gets better on its own within weeks to months. Infants born to infected mothers should receive hepatitis B immune globulin and the hepatitis B vaccine within 12 hours of birth to help prevent infection.

Hepatitis B can progress to become a chronic infection. The risk for chronic infection varies according to the age at infection and is greatest among young children. Approximately 90% of infected infants and 25%-50% of infected children aged 1-5 years will remain chronically infected with HBV. By contrast, approximately 95% of adults recover completely from HBV infection and do not become chronically infected. Chronic Hepatitis B can lead to scarring of the liver (cirrhosis), liver failure, or liver cancer.  Drugs that are approved for the treatment of chronic hepatitis B include alpha interferon, which slows the replication of the virus in the body, and antiviral drugs such as entecavir and tenofovir. A vaccine to prevent Hepatitis B is available. The CDC recommends that all infants and unvaccinated children, adolescents, and at-risk adults should receive this vaccine. The rate of new HBV infections has declined by approximately 82% since 1991 thought to be primarily due to the routine vaccination of children.

 Hepatitis C is spread primarily through contact with infected blood.  Before 1992, when widespread screening of the blood supply began in the United States, Hepatitis C was commonly spread through blood transfusions and organ transplants.  Hemodialysis patients and health care workers are also at higher risk of contracting Hepatitis C.  Less commonly, it can spread through sexual contact and childbirth. Only 20-30% of people newly infected with Hepatitis C will develop characteristic hepatitis symptoms.  The disease is more commonly detected via testing of asymptomatic people who are at high risk for infection. Hepatitis C is usually not treated unless it becomes chronic. It is estimated that 2.7-3.9 million people in the United States have chronic hepatitis C which can lead to the development of cirrhosis, liver failure, or liver cancer.  Chronic Hepatitis C infection is the leading indication for liver transplants in the United States. Fortunately, treatment of chronic Hepatitis C is becoming more and more effective. There is no vaccine for Hepatitis C. The best way to prevent Hepatitis C is by avoiding behaviors that can spread the disease, especially injection drug use.

Hepatitis viruses A, B, and C are the most common, but there are other hepatitis viruses that can infect the liver.  Hepatitis A usually a self-limited disease but Hepatitis B and C can develop into a chronic illness that produces very serious liver damage. Immunization for Hepatitis A and B virus has brought down the incidence of disease from these viruses significantly. Treatment of chronic Hepatitis C has progressed to the point where it may become a curable disease in the future.
Sources for article:
Hepatitis A from the National Institute of Diabetes and Digestive and Kidney Disease
Hepatitis B FAQs for Health Professionals from the U.S. Centers for Disease Control and Prevention
Hepatitis C FAQs for Health Professionals from the U.S. Centers for Disease Control and Prevention

Thursday, October 6, 2016

What's New with Influenza Immunization for 2016-2017

There is no question but that an epidemic of influenza will occur during the 2016-2017 "flu season".  What is not known is when this epidemic will happen, the specific strains of flu virus responsible for illness, or the number or severity of cases of flu that will occur.  For that reason, the Advisory Committee on Immunization Practices (ACIP) recommends that everyone 6 months and older receive the flu vaccine.
Every year certain things change regarding influenza immunization.  Important aspects of this year's recommendations from the ACIP Include:
  1. Only injectable flu shots are recommended for use this season. Last year, the use of a nasal flu vaccine (live attenuated influenza vaccine or LAIV), was included as one of the option for flu immunization. This method of delivery was commonly used in children since it did not require receiving a "shot".  Because of concerns about its effectiveness, however, the ACIP does not recommend it use during the 2016-2017 flu season.
  2. Some flu vaccines are made using eggs which has raised concern regarding the possibility of causing an allergic reaction in someone with an egg allergy. The recommendations from the CDC for people with egg allergies have been updated for this season:
  • Anyone who has experienced only hives after exposure to egg can get any licensed flu vaccine that is otherwise appropriate for their age and health.
  • Someone who has had more severe symptoms, such as angioedema (swelling that affects deeper layers of the skin, often around the eyes and lips), breathing difficulty, lightheadedness, or recurrent vomiting can also receive any licensed flu vaccine that is otherwise appropriate for their age and health.  The vaccine, however, should be given in a medical setting (hospital, clinic, health department, physician's office) and be supervised by a health care provider who is able to recognize and manage severe allergic conditions.
  1. Since human immune defenses become weaker with age, people 65 years and older are at greater risk of serious complications from the flu compared with young, healthy adults. Last year, the U.S. Food and Drug Administration (FDA) licensed a new seasonal flu vaccine for adults 65 years of age and older. It contains an adjuvant, which is an ingredient added to the vaccine to create a stronger immune response to vaccination. This vaccine is marketed under the trade name FLUAD™ and will be available during the 2016-2017 flu season. Some studies have shown that FLUAD™ was significantly more effective in preventing influenza as compared to a standard influenza vaccine.  The previous recommendation that individuals over the age of 65 receive a "high dose" flu vaccine remains in effect for the 2016-2017 flu season also.  
It is impossible to predict whether this year's vaccine will be a good match with the viruses that are ultimately found to be responsible for causing flu this season. Experts have to make an educated guess as to the strains that are likely to be responsible and make sure that the vaccine includes protection against these strains. Even if the match isn't ideal, however, the antibodies made in response to vaccination against one type of flu virus often provide protection against other flu viruses.  Overall the 2015-2016 season was relatively mild, but don't let that lead to complacency regarding getting your flu shot.  While not 100% protective, it is still the most effective way to reduce one's risk of contracting influenza.

Source for article:
Influenza (Flu) from the Centers for Disease Control and Prevention