Are OB-GYN Well Visits Short-Changing Women?

During their childbearing years, many women view their obstetrician-gynecologists as primary care physicians, seeing them for preventive health care as well as for reproductive-related issues. Several studies, including one published in 2014 in the Journal of the American Medical Association (JAMA), indicate that women may be shortchanging themselves by consulting only an OB-GYN for preventive health care visits. The national study of 63 million preventive health visits by non-pregnant women found that those “of reproductive age who see OB-GYNs only for preventive care may not be receiving the full spectrum of recommended screening and counseling.”

A number of Connecticut OB-GYNs and other women’s health care specialists said, however, that they are aware of the unique role they play, and that they make a point of addressing patients’ broader needs, especially when meeting a new patient. These needs vary, of course, depending on a woman’s lifestyle, risk factors and age. “If you’re young, in your 20s, don’t smoke and are healthy, you’re very low risk,” said Dr. Susan Richman, a Branford OB-GYN.   “What [those patients may] have is very treatable, and I’m comfortable treating them.”

The JAMA study of “well-woman” visits from 2007 to 2010 showed that while OB-GYNs generally screened for cervical and breast cancers, chlamydia and osteoporosis, general practitioners more often screened for colorectal cancer, cholesterol counts and diabetes.

Research: Most-Effective Breast Cancer Treatment Should Address Obesity, Integrate Exercise

Yale cancer scientist Melinda Irwin says that the connection between obesity and cancer are so strong — as are recent findings about the effectiveness of exercise and diet in treating cancer — that pharmaceutical companies should be required to include these two lifestyle components in drug trials. A mandate is needed, Irwin said, because the pharmaceutical industry, which funds most large-scale drug trials, “has no incentive to fund lifestyle behavioral interventions. Why would they? There’s no pill to take.”

Irwin studies the effects of weight loss and exercise on breast cancer survivors. Her comments echo those by the American Society of Clinical Oncology, which has issued a new position paper calling obesity “a major unrecognized risk factor for cancer.’’

“As many as 84,000 cancer diagnoses each year are attributed to obesity, and overweight and obesity are implicated in 15 percent to 20 percent of total cancer-related mortality,” the group says in its position paper published in the online version of the Journal of Clinical Oncology Oct.

Exploring Black Cohosh, Hot Peppers, In Breast Cancer Treatment

Dr. Erin Hofstatter, a young research scientist and breast cancer specialist at Yale’s Smilow Cancer Hospital, often prescribes tamoxifen, raloxifene and similar drugs to her patients. The drugs “reduce your risk (of cancer recurring) by half … but they come with baggage,” she tells her patients, “hot flashes, night sweats, leg cramps, small risk of uterine cancer, small risk of blood clots, small risk of stroke, you have to get your liver tested.”

Hofstatter’s unease with standard treatments for breast cancer has spurred her to seek alternative, safer ways to treat breast cancer. To this end, she has begun a study of black cohosh, in the pill form of an herb from the buttercup family, used for thousands of years by Native Americans to treat menopausal symptoms.

“There’s data to suggest that [black cohosh] is protective,” she said, “both in breast cancer survivors and potentially preventive in women who’ve never had breast cancer, based on a few large observational trials.”

Just as practices like acupuncture and meditation – once considered, at best, nontraditional are now widely used to help patients cope with the side-effects of cancer treatments and other illnesses, natural products – foods (blueberries, walnuts, soy), herbs like black cohosh and plant-based anti-oxidants like capsaicin (which makes hot peppers hot) have become accepted subjects for research. But far from simply embracing these practices or foods, scientists now apply rigorous scientific methods to what are considered non-traditional medications to determine just how effective – or ineffective — they are. A similar scientific focus is being directed at exercise, diet, and meditation.