Our expert is Melissa McNeil, MD, MPH, Chief, Section of Women’s Health, Division of General Internal Medicine, University of Pittsburgh. She is affiliated with multiple hospitals in the area, including Magee-Women’s Hospital of UPMC and UPMC Presbyterian Shadyside.
Dr. McNeil is perennially one of the most popular speakers at the Academy of Women’s Health April Conference. Be sure to attend Women’s Health 2016: The 24th Annual Congress, April 14-17, 2016 in Washington, DC to hear her in person.
CALCIUM AND VITAMIN D RECOMMENDATIONS ARE CHANGING
Our long-standing emphasis on calcium and vitamin D supplementation is currently being called into question. In the case of calcium supplementation, there are downsides that in many cases may outweigh the benefits. In the case of vitamin D supplementation, we are not seeing obvious downsides, but neither are we seeing enough benefit to make a strong case for advocating for supplementation.
There are cases where calcium supplementation is indicated, including people who: follow a vegan diet; have lactose intolerance; have osteoporosis; are receiving long-term treatment with corticosteroids; or have digestive diseases that interfere with the absorption of calcium.
However, for patients who aren’t at obvious risk for inadequate calcium, the risks of supplementation may exceed the benefits. Too much calcium can mean an increased risk of heart attack, stroke, muscle pain, mood disorders, and kidney stones.
Vitamin D supplementation does not have a strong downside risk. However, current research is telling us that the benefits do not seem as strong as we once thought. We need vitamin D, but the issue is, how much do we need? In the past we felt that people with calcium levels below 30 ng/mL would need supplementation, but current research is causing us to rethink what normal levels of vitamin D are. Current research indicates that a much smaller percentage of women will actually benefit from vitamin D supplementation.
GUIDELINES FOR BREAST CANCER SCREENING HAVE BEEN UPDATED
The American Cancer Society has been studying which approach to breast cancer screening improves health, avoids harm, and eliminates wasteful practices. The current recommendations from the American Cancer Society for average-risk women are: discuss the potential benefits (small reduction in breast cancer mortality) and harms (high false-positive rate, over-diagnosis) of screening with women aged 40-44 and perform annual mammograms in women who opt for screening; perform mammography yearly in women aged 45-54; for those women 55 and older, every 2 years with the choice to continue yearly. Screening should continue every two years as long as a patient is in good health and has a life expectancy of at least 10 years. I now follow these guidelines. They are clear, easy, and evidence based.
BREAST DENSITY AND THE NEED FOR ADDITIONAL SCREENING
Twenty-one states in this country require that patients be notified that they need to talk with their health care provider if tests show that they have increased breast density. However, the new data suggest that other risk factors in conjunction with breast density should determine who should get additional testing. These other risk factors would include all the traditional risk factors for breast cancer such as a strong family history of breast cancer, a previous breast biopsy, early menarche or late menopause.
INDIVIDUALIZE THE LENGTH OF TIME A WOMAN IS ON HORMONE REPLACEMENT THERAPY
New guidelines from the American Congress of Obstetricians and Gynecologists (ACOG) strongly support an individualized approach to how long an older woman should be on hormone replacement therapy (HRT). Some women have troubling and persistent symptoms, such as hot flashes, well into their 60s. If a woman has no contraindications for HRT, such as a family history of breast cancer or diabetes, an arbitrary stopping time doesn’t make sense.
GENETIC TESTING IS VALUABLE FOR ADJUVANTCHEMOTHERAPY
A new study validates the use of genetic testing for determining who will benefit from getting adjuvant chemotherapy. Initially, the recommendation was that all women should get adjuvant chemotherapy. However, new data show that genetic testing can determine who will benefit from it and who can be spared chemotherapy.