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An A-Z Woman's Guide to Vibrant Health
Appendix C
Diagnostic Tests and Types of Treatments for Women's Health
BREAST HEALTH
Breast Self-examinations
Breast Self-Examination (BSE) does not prevent cancer, but many women
discover abnormalities in their breasts during regular home testing. Perform
the exam the day after your period ends each month. Or, for non-menstruating
women, pick the same day each month. Follow these directions to perform
your self-examination:
- Lie down and put a pillow under your right shoulder. Place your right arm
behind your head.
- Use the finger pads of your three middle fingers on your left hand to feel for
lumps or thickening in your right breast. Your finger pads are the top third
of each finger. Press firmly enough to know how your breast feels. Learn
what your breast feels like most of the time. A firm ridge in the lower
curve of each breast is normal. You can either make a circle or move your
fingers up and down.
- Move around the breast the same way each time you do the examination so
you are aware of any changes.
- Switch the pillow to your other shoulder, and repeat with your left breast,
using the right-hand finger pads.
- Repeat the examination of both breasts while standing, with one arm
behind your head. The upright position makes it easier to check the upper
and outer parts of the breasts (toward your armpit). (You may want to do
the standing part of the BSE while you are in the shower. Some breast
changes can be felt more easily when your skin is wet and soapy.)
- Check your breasts for any dimpling of the skin, changes in the nipples,
redness, or swelling while standing in front of a mirror right after your
BSE each month.
Remember that most women have lumps or lumpy areas in their breasts, so
don't panic if you find a lump. Report any changes to your doctor. A clinical
examination is very much the same as BSE, except that a trained professional
may discover abnormalities that you may find insignificant. Both examinations
are considered important in detecting cancers early.
Mammogram
Every October, during Breast Cancer Month, national campaigns encourage
you to "prevent" breast cancer by having your annual mammogram. A
mammogram does not prevent breast cancer. It is a diagnostic tool, albeit,
as we are discovering, not the most effective one.
Danish researchers reviewed seven randomized, controlled mammogram trials
that supported the benefits of mammography in reducing the rate of death
from breast cancer. They found that, out of the seven trials, five were so
flawed they could not be considered useful; the two remaining trials also had
problems. Researchers determined that mammograms had no effect on
reducing deaths due to breast cancer. Published in the Journal of the National
Cancer Institute (JNCI), a more recent study that followed over 40,000
women between the ages of 50 and 59 found mammograms do not reduce
death rates from breast cancer any better than a simple breast exam.
Mammogram Concerns
The chance of receiving a false positive from mammography is substantial
(meaning you have been diagnosed with a cancer when there is none),
according to the JNCI.Women in their 40s are at higher risk of false positives
due to dense breast tissue. Women who have been taking hormone replacement
therapy (estrogen and progestins) have much denser breast tissue,
making it difficult to detect abnormal tissue.
A study published in the Journal of the American Medical Association found
that women age 70 and older had little to no benefit from regular mammograms.
The Lancet reported that breast compression, which occurs during
mammography, may cause tumors to rupture, spreading cancer cells.
The safety of repeated ionizing radiation from mammograms has been questioned
amid concerns that it may increase the risk of breast cancer.
What's a woman to do? Researchers reported to the 39th Annual Meeting
of the American Society of Oncology that Magnetic Resonance Imaging
(MRI) offered, by far, the highest sensitivity for diagnosing breast cancer -
with the lowest rate of unnecessary biopsies. An MRI uses magnetic energy,
not X-rays, to view the breast tissue. They found that MRIs provided 96.1
percent accuracy in reporting positive results, compared to mammography
(42.8 percent accurate) and ultrasound (41 percent accurate). We need to
insist on better detection methods. Ask your doctor about MRI as an alternative
to mammogram. Women should have a baseline breast MRI performed
at 40 and then start annual MRIs at age 50.
Thermography
Another promising screening tool is thermography, which is less expensive
and sometimes easier to obtain than an MRI.
In order to survive, a cancer tumor has to develop a supply of nutrients. In the
early stages, it does this by stealing blood supply and nutrients from nearby
cells. This process of angiogenesis continues until the blood cells form tiny
capillaries that reach the tumor and start the supply of oxygen and nutrients
that fuels rapid growth of the cancer. As the cancer grows, it forms a lump that
can be felt during a clinical exam or seen on mammogram, but, long before a
lump is felt, heat is produced that can be detected via thermography.
All of this activity within the breast causes changes in the surface temperature
of the skin. Thermography, or infrared imaging, is a non-invasive, painless
technique that can indicate breast abnormalities, including benign tumors, cancer,
fibrocystic breast disease, mastitis or other health issues, at very early stages.
In fact, sensitive thermographic equipment is able to detect potential cancers
at the stage where blood is pooling near the tumor site. Although thermography
is not able to pinpoint the exact location of a tumor, it is extremely
useful as a predictor of future cancer risks and, combined with other tests,
could help to prevent invasive tumor growth.
During the procedure, a woman sits in a cool room, and removes her clothing
from the waist up. Although her skin temperature will drop and blood activity
will slow, cancerous and pre-cancerous cells are highly active and operate independent of the nervous system. As a result, these areas will continue to produce heat that will be
captured by the sensitive infrared camera.
Thermography is effective for detecting angiogenesis in dense breast tissue,
so it is suitable for young women as well. Annual thermograms should
become part of every woman's breast-health protection strategy especially if
you have decided not to have a mammogram or MRI.
REPRODUCTIVE HEALTH
PAP test
A Papanicolaou Test (PAP) should be performed annually after age 18 or
before, if the woman is sexually active, and/or taking the birth control pill.
The PAP test, also called the PAP smear, is a diagnostic test used to detect
abnormal cell growth on the cervix. During this test a speculum is inserted
into the vagina and the cells of the cervix are gently scraped off to be examined.
This test does not hurt.
Cancer of the cervix develops when the cells on the surface of the cervix
divide and grow uncontrollably. It takes years for this cancer to develop and
during this time, normal cells change. This change can be detected by a
PAP test. We call these abnormal cells which have not become cancerous
dysplasia. Mild dysplasia can develop into severe dysplasia, and then cancer,
if left untreated.
HPV and abnormal PAP tests: Human papilloma virus, a virus that causes the
growth of warts, is often associated with cancer of the cervix and/or dysplasia,
chronic urinary tract infections, vaginosis and vaginitis. HPV is considered
the most common sexually transmitted disease. It should not be confused
with sexual promiscuity; women who have had the same partner for 20
years can contract HPV. Women who have abnormal PAP tests should also
be tested for HPV. Of the more than 70 HPV types that have been identified,
about 30 infect the cervix.
More often an abnormal PAP test is a result of hormonal changes (women
on the Pill have a higher rate of abnormal PAP tests), menopause, douching,
infection, Candida overgrowth and irritation or inflammation.
Classification of PAP test results
There are two classification methods commonly in use today: the Bethesda
System and the CIN Grading System.
Bethesda System:
- ASCUS (atypical squamous cells of undetermined significance)- Borderline,
some abnormal cells
- LGSIL (low-grade squamous intraepithelial lesions) - Mild dysplasia and
cellular changes associated with HPV
- HGSIL (high-grade squamous intraepithelial lesions) - Moderate to severe
dysplasia, precancerous lesions and carcinoma in-situ (preinvasive cancer
that involves only the surface cells)
CIN Grading System: CIN stands for Cervical Intraepithelial Neoplasia. This
system grades the degree of cell abnormality numerically.
Atypia - correlates with ASCUS
CIN I - mild dysplasia and correlates with LGSIL
CIN II - moderate dysplasia and correlates with HGSIL
CIN III - severe dysplasia and correlates with HGSIL
Carcinoma in-situ
Cervical cancer
To find out how to normalize PAP smears, see Cervical Dysplasia.
Ultrasound
Any type of abnormal bleeding or pelvic pain should be evaluated with a
pelvic ultrasound (sonography). An ultrasound scan uses high-frequency
sound waves that are sent to the body part being examined; these waves are
reflected back and displayed on a monitor screen. Pelvic sonography is used
to examine the pelvic cavity, ovaries, uterus, endometrium, fallopian tubes,
bladder, kidneys and ureters. It is also used to evaluate infertility and to
monitor fetal health during pregnancy. Pelvic ultrasounds can be performed
vaginally (vaginal ultrasound) or externally, on the belly. Women are asked
to consume plenty of water before the procedure so the sound waves can
bounce off the bladder for the best possible image.
TREATMENT
Hysterectomy
A hysterectomy is the surgical removal of the uterus, the organ that holds
a baby during pregnancy. With over 772,000 operations annually in the
U.S. and 60,000 in Canada, hysterectomy is the second most common
surgery performed on women, after cesarean section. Before the age of 60,
one in three American women will have had a hysterectomy. In Canada,
the number is closer to 37 percent. The main reason for hysterectomy is
uterine fibroids, which result in heavy periods and anemia, while
endometriosis is the second leading cause. Be sure to read the appropriate
sections of this book for alternative treatments for these conditions. (See
Myomectomy and Uterine Artery Embolization in this section; see also
Uterine Fibroids and Endometriosis.)
About 16 percent of hysterectomies are due to uterine prolapse. This occurs
when the uterus relocates from its normal position and falls further into the
vagina. Prolapse occurs due to weakened ligaments and supportive tissues
that frequently result from childbirth, lack of exercise, hormone imbalance
at menopause (particularly testosterone deficiency) or obesity. Before considering
removal of the uterus, women should try other options including
exercise, Kegal exercises or the use of a pessary. Kegel exercises involve
squeezing the muscles of the pelvic floor, vagina and buttock muscles.
Squeeze, hold and release several times per day. Practice Kegal exercises
while urinating. Start and stop the urine stream to improve bladder control
while improving internal pelvic muscles.
A pessary is a plastic ring that is inserted into the vagina to support the uterus.
Alternatively, less traumatic surgery can tighten the muscles and ligaments
around the uterus to help hold it in place. In about ten percent of cases, hysterectomies
are performed due to cancers of the reproductive tract.
Many believe that the uterus is a useless organ after a woman has finished
having babies. Evidence shows that the uterus plays a role in immune function - it produces the prostaglandins responsible for a variety of physiological
functions. The uterus helps in prevention of cardiovascular disease through the production of prostacyclin, which prevents blood clots. The uterus also secretes a small amount of
estrogen. Women who have had hysterectomies also
appear to be at increased risk of osteoporosis and osteoarthritis. Hysterectomy
also impacts libido: in some women the removal of the uterus causes an abrupt
end to her sex drive. In fact, particularly in the case of hysterectomy due to
prolapsed uterus, research shows that 50 percent of hysterectomies end sexual
intercourse permanently. The reason for this can be due to the surgeon
damaging nerves or inhibiting blood flow to the clitoris or pelvic region.
Surgical Risks: Any surgery has risks, but women who are obese, or who have
high blood pressure, diabetes or other chronic conditions are at increased
risk. Complications of surgery include damage and scarring of surrounding
internal organs such as the ureters (tubes which carry urine from the bladder
to the kidneys), the rectum and the bladder. Deep vein thrombosis involves
blood clots that form in the legs but break free and move to the lungs where
they can get trapped, causing a potentially fatal embolism. Women who
have hysterectomies before menopause may suddenly experience severe
menopause symptoms. (See Menopause)
Types of Hysterectomy: With the exception of cancer treatment, hysterectomy
should only be performed after you have exhausted all of the options
discussed in this book. If you must have a hysterectomy, discuss all of your
concerns and evaluate all your choices before proceeding. Also, find an
skilled surgeon.
- Complete or Total Hysterectomy: Also known as a pan-hysterectomy, this
is the most commonly performed operation. It involves the removal of the
entire uterus, with or without the ovaries. Most women think a total
hysterectomy means the removal of the ovaries, but that is false.
- Partial Hysterectomy: Also known as a supracervical hysterectomy, this
surgery leaves leaves the cervix and the ovaries in place; only the uterus is
removed.
- Bilateral Salpingo-oophorectomy: This procedure removes the ovaries and
fallopian tubes on both sides of the uterus. This can be done with or without
the removal of the uterus.
- Radical Hysterectomy: As its name implies, this procedure removes the
uterus, the cervix, the ovaries, the upper part of the vagina and other supporting
tissues.
Procedure: A hysterectomy can be performed either with an abdominal incision
or through the vagina. During an abdominal hysterectomy, the surgery is
performed through an incision in the abdomen. Surgeons may be able to use
a bikini-line incision just above the pubic bone, but often the incision is
made vertically.
Vaginal hysterectomies are performed through the vagina. In this form of
surgery the cervix is removed as well. Vaginal hysterectomy patients have
shorter recovery times because there is no abdominal incision.
LAPAROSCOPY
Laparoscopically assisted vaginal hysterectomies involve the use of a small
viewing tube (a laparoscope) through an incision in the abdominal wall.
Laparoscopy, where an incision is made in the bellybutton, is done for many
types of female conditions, including the diagnosis or removal of endometriosis,
ovarian cysts or to evaluate unexplained pelvic pain. During a laparoscopy,
usually a very tiny incision is made in the bellybutton and another at the side
of the abdomen and one just above the pubic bone. One is for the laparoscope
and the others for the surgical instruments. The abdomen is filled with air for
ease of viewing.
MICROWAVE ENDOMETRIAL ABLATION (MEA)
Microwave ablation is currently being studied by the medical community as an
alternative to surgery for a variety of conditions including heart surgeries as
well as a method of treating liver tumors, prostate cancer and breast cancer. In
fact, a study published in 2003 showed that microwave ablation was able to
halt the growth of early-stage breast tumors in 68 percent of women tested.
While still in its infancy as a treatment for breast cancer, microwave endometrial
ablation has gained wide acceptance as an alternative to hysterectomy for
women with fibroids and menorrhagia (heavy menstrual bleeding).
MEA uses high-frequency microwave energy to heat and destroy the lining of
the uterus, or the endometrium. Before microwave endometrial ablation is
performed, women are given hormones to further thicken the uterine lining.
Then, to prevent perforating the uterus, a woman typically undergoes an
ultrasound to determine the minimal thickness of the uterine wall. During the
procedure, the cervix is dilated and the doctor inserts a wand-like device into
the uterine cavity. The surgeon then moves the applicator around the uterus
to destroy the lining. The temperature of the device is strictly monitored, and
has an automatic shut-off valve if temperature rises too high. The procedure
is carried out under local or general anesthetic and typically takes less than
ten minutes to complete. The uterus no longer functions as it used to and
pregnancy cannot occur once this treatment has been completed.
MEA has a shorter recovery time than hysterectomy, and the uterus is not
removed from the body. Similar to hysterectomy, MEA is not an option for
women who are considering pregnancy.
Myomectomy
Uterine fibroids affect a vast number of women. Many exhibit no symptoms,
while others have pain or abnormal bleeding. (See Uterine Fibroids)
Although hysterectomy is often the first choice to deal with the problem, a
less invasive procedure called myomectomy surgically removes the fibroids
but leaves the uterus intact. A method called hysteroscopic resection can
remove fibroids located inside the uterus through the cervix without the
need for an incision. Some fibroids lodged partially in the wall of the uterus
and partially in the uterine cavity can also be removed using this procedure.
Laparoscopy can often treat fibroids on the outside of the uterus. Larger
fibroids can be removed through abdominal surgery, which has a healing
time similar to a hysterectomy, but again, leaves the uterus in place.
Myomectomy is the recommended treatment for infertility caused by the
uterine fibroids in women still wishing to conceive.
Uterine Artery Embolization
A relatively new procedure, uterine artery embolization (UAE) is used to
cut off the blood supply to the arteries that feed the fibroid. Small particles
of polyvinyl alcohol about the size of a grain of sand are injected into the arteries, and the blockage causes the uterine fibroid to shrink in size or die and symptoms improve. The
particles are locked into the vessels so they do
not travel through the body. This procedure is not readily available in all
communities and there have been reports of emergency hysterectomies
having to be performed as a side effect of UAE. Because the long-term
effects are not yet known, women considering pregnancy are not suitable
candidates for UAE.
THYROID HEALTH
Thyroid Stimulating Hormone (TSH) thyroid test
Laboratory Tests: TSH, T3 and T4. The normal levels for the TSH test are
so broadly defined that most patients with functional problems are not
clinically diagnosable. Yet it takes very little change in the pituitary stimulating
hormone TSH to cause dramatic changes in thyroid function. It is a
mystery why the allopathic definition of the normal range for TSH is so
wide, given the extreme sensitivity of the thyroid to even minute variations
in TSH levels.
Many people suffer with mild or sub-clinical low thyroid function. Their
thyroid stimulating hormone (the hormone that stimulates the thyroid to
make thyroid hormones) is greater than 2.0 IU/ml but less than the 5.5
IU/ml level indicative of hypothyroidism. As such, these people contend
with the many symptoms of low thyroid function, but are not being treated
with medication. For more information on Thyroid function, see Thyroid.
For additional information on T3, please refer to the work of Dr. E. D.
Wilson, Wilson's Syndrome: The Miracle of Feeling Well.
Thyroid Basal Temperature Home test
Monitoring your basal temperature is the most sensitive and accurate way
to evaluate thyroid function; it is also the simplest and least expensive. The
thyroid sets the thermostat for the body and regulates the rate of
metabolism in nearly all of the cells. Therefore, the most reliable window
on thyroid function is the basic body temperature, or basal temperature.
Some health care practitioners call basal temperature the axillary temperature
because it is measured in the armpit. It is measured at the same time
every day - as soon as you wake up in the morning, before arising.
LOW THYROID HOME TEST
- Your basal body temperature, meaning the temperature of your
body at rest, is the most sensitive test of thyroid function. Note:
Menstruating women must perform the test on the second, third
and fourth days of menstruation. Men and postmenopausal women
can perform the test any time.
- Take the test as soon as you wake up because it is important to
take your temperature after you have had adequate rest.
- Before going to sleep, if you are not using a digital thermometer
shake a regular thermometer to below the 95 degree mark
and place it by your bed (ready to be used in the morning).
- Immediately upon waking, before you get out of bed, place the
thermometer in your armpit (hold for a count of 10 if you are using
a regular thermometer). Hold your elbow close to your side to keep
the thermometer in place.
- Read and record the temperature and date.
- Repeat the test for three mornings (preferably at the same time
every day).
- A reading between 97.6 and 98.2 degrees F is normal. Readings
below 97.6 may indicate hypothyroidism.
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The research on basal temperature as the most accurate measurement
for thyroid function was done by Dr. Broda Barnes, who has more than
40 years of clinical experience with thyroid patients. Look for both books
authored by Broda Barnes, Heart Attack Rareness in Thyroid-Treated Patients
and Hypothyroidism: The Unsuspected Illness.
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