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Healthy Breasts & Cervix

april2009tanyawylde-071Breast Health & Cervix Health

Naturopathic doctors are trained in clinical breast examinations (CBE), vaginal swabs and PAP examinations.   Dr. Tanya Wylde performs these examinations only if indicated or requested by her patients as she does not want to cause unnecessary anxiety surrounding breast health or cervical health if a women is already being monitored by her family doctor.   Dr. Wylde encourages regular clinical breast exams, mammography (beginning after 50 years old or earlier if indicated), breast thermography (starting before 40 years old) and PAP examinations and she is trained in the interpretation of all of the above examinations and assessments.  If there is any indication of pre-menstrual breast tension, fibrocystic breasts, breast cancer, abnormal cervical cells,  or abnormal vaginal flora she is equipped with naturopathic treatments that can complement conventional treatments.  Dr. Wylde aims to improve a woman’s overall health so that she can better heal from these conditions.  In the event that cancer is present the aim is to help patients be stronger and healthier to better handle the conventional treatments such as chemotherapy and radiation.  If there is a personal or family history of poor breast or cervical health Dr. Wylde aims to prevent the above conditions from arising with naturopathic treatments including but not limited to nutrition, physical exercise, supplementation and herbal medicine.

Breast assessments:

Clinical breast exams

Clinical breast exams start with a visual exam where we are looking for symmetry, skin conditions and nipple changes.  Followed by a manual examination of your breasts where you will be asked to lie down and put your arms back over your head while your breasts and lymph nodes are being examined.  If you need to learn how to do your monthly breast self-exam, we will coach you during your clinical breast exam.  As you would do for your breast self-exam, your naturopathic doctor will use finger-pad pressure to feel all areas of your breast tissue. Breasts are made of fatty and glandular tissue, and will vary in density. Dr. Wylde will palpate each breast with three levels of pressure: A: Light Pressure for superficial breast tissue
 B: Medium Pressure for intermediate layer
 C: Deep Pressure for tissue close to chest wall.  This is not intended to cause pain or discomfort – but is done to make sure that the manual exam is thorough. If you have pain during your CBE, let Dr. Wylde know immediately.  Any breast lumps or shape changes will get special attention – as well as the way the lumps respond to pressure and move within breast tissue. The size and location of any lumps and bumps will be noted, and if you will be having a screening mammogram, or breast thermography your radiologist will pay special attention to those areas.

The American Cancer Society (ACS) recommends that women 20 to 39 get a clinical breast exam (CBE) once every three years during their annual well-woman visit. Your primary doctor may do one at every yearly check-up. When you are 40 and older, the ACS recommends that you get a CBE annually. Having a clinical breast exam is a great way to keep an eye on your breast health.

Breast Thermography

Thermography measures the infrared radiation (heat), which is constantly radiating (emitting) away from the surface of the human skin.  The procedure is based on the principle that chemical and blood vessel activity in both pre-cancerous tissue and the area surrounding a developing breast cancer is almost always higher than in the normal breast.  Since pre-cancerous and cancerous masses are highly metabolic tissues, they need an abundant supply of nutrients to maintain their growth. In order to do this they increase circulation to their cells by sending out chemicals to keep existing blood vessels open, recruit dormant vessels, and create new ones (neo-angiogenesis). This process results in an increase in regional surface temperatures of the breast.

Abnormal thermographic scans of the breast clearly demonstrate abnormal areas of heat. This gives the clinician an alert that something might be wrong with physiology of the breast.   It could be an infection, inflammatory disease, trauma or cancer.  Because of breast thermography’s extreme sensitivity, these temperature variations and vascular changes may be among the earliest signs of breast cancer and/or a pre-cancerous state of the breast.

Thermography uses no painful breast compression, no radiation and is non-invasive. It is an ideal tool for mass screening not only for women over 40, but younger women as well especially with a strong family history of breast cancer.

Breast thermography has been researched for over 30 years, and over 800 peer-reviewed breast thermography studies exist. Some of these studies have followed patients up to 12 years. Breast thermography has an average sensitivity and specificity of 90%.

Breast thermography is not a stand-alone tool in the screening and diagnosis of breast cancer. It is adjunctive. We cannot however, ignore the tremendous role of thermography as an early risk indicator or as a monitor of treatment. When a thermography is positive, a closer look at the patient’s diet, exposure to environmental pollution, toxins and lifestyle is in order.  Ultrasound and mammography are also essential when a breast thermography is abnormal.  When mammography and breast ultrasounds are negative or equivocal, thermographic monitoring on a quarterly to semi-annual basis should be performed in those patients with suspicious thermograms.

Since it has been determined that 1 in 8 women will get breast cancer, we must use every means possible to detect cancers when there is the greatest chance for survival. Proper use of breast self-exams, physician exams, thermography, ultrasounds and mammography together provide the earliest detection system available to date. If treated in the earliest stages, cure rates greater than 95% are possible.

Read more on breast thermography at this link in the “Huffington Post” written by Christiane Northrup, MD.

We refer outside the clinic for Breast Thermography.

Cervix assessments:

Naturopathic doctors are trained in performing PAP smears to assess the health of the cervix, bi-manual examinations to assess the health of the ovaries and vaginal swabs to assess the health of the vaginal flora.  Dr. Wylde finds many of her patient’s request PAP examinations as apart of their naturopathic physical examinations possibly because we she is a female doctor and her patients feel more comfortable with the time she spend to ensure that her patients are comfortable during this type of sensitive examination.  When a naturopathic doctor does a pap smear in Ontario it is not covered by OHIP but is often covered by extended health insurance plans.  When performed as part of a regular visit the patient is billed for the visit in addition to the cost of the pap smear test (30$).  Dr. Tanya Wylde also offers vaginal swabs for bacterial vaginosis and candida when these are suspected.

Cervical Cancer Screening Guidelines for Teens, Young Women, and Seniors

Recommendations from the American College of Obstetricians and Gynecologists (ACOG) are promoting a change in the frequency of cervical cytology screening (Pap smears). This was published in the December 2009 issue of Obstetrics & Gynecology, the ACOG recommendations are in keeping with contemporary medicine’s use of evidence-based guidelines, notes George Sawaya, MD, in the New England Journal of Medicine.

Three points on PAP exams that are worth noting:

▪   Wait until age 21: Cervical cancer screening should begin when a woman is 21 years old, regardless of her sexual history. ACOG guidelines now advise that females under the age of 21 should not have a Pap smear because they have a very low risk of cervical cancer. Routine screening before this age promotes unneeded and possibly harmful consequences due to overtreatment. This may have adverse impact on finances, emotions, fertility, and even future pregnancies.

▪   Test every 2 years in your 20s: The ACOG now recommends Pap tests every 2 years for women between 21 and 29 years of age.

▪   Testing in your 30’s and older: ACOG’s recommendation for women over 30 with no risk factors hasn’t changed and remains at every three years after 3 consecutive tests with negative results.

▪   If your history is good, stop at 65 to 70: ACOG recommends discontinuing cervical cancer screening between the ages of 65 and 70 years, if you have had three or more negative Pap smears and no other abnormal test results in the past 10 years. For sexually active women with new or multiple partners or with other risk factors, screening may still be appropriate.

These changes help protect women from the potentially harmful after effects of over-screening for cervical cancer, yet maintain the strong, proven benefit of Pap smear testing, notes Sawaya, MD.  Variations in frequency may be warranted “based on the needs of the individual patient, resources, and limitations unique to the institution or type of practice,” the guidelines note. Examples of those needing annual testing are women with weakened immune systems, cervical abnormalities, HIV infection, or exposure to the chemical DES (diethylstilbestrol).

Women vaccinated against human papillomavirus (HPV) are advised to follow the frequency guidelines as outlined above for unvaccinated women. HPV screening is not recommended for women under 21 years of age. It is also not recommended to test women between 21 and 30 years for HPV unless their Pap smear is abnormal. It is recommended that women over 30 years old should be co-tested for HPV at the time their Pap smear is obtained.

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