Seattle Met Women's Health 2013

Cutting Edge: Advances in Medicine p5

Infertility and the Struggle to Conceive p8

The Ugly Truth About Skin Cancer p12

Breakthroughs in Breast Reconstruction p20

Women’s Health Annual 2013 presented by Seattle Met

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Contents SagaCity Media President Nicole Vogel Publisher Rob Scott Editorial Director Bill Hutfilz Senior Editor Julie H. Case

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Associate Editor Angela Cabotaje Design Director André Mora Art Director Chuck Kerr

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Contributing Writers and Editors Nancy Schatz Alton, Sarah DeWeerdt, Michelle Goodman, Christy Karras, Diane Mapes, Katie Vincent, Cameron Walker Contributing Illustrator Britt Sanders

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Images Shutterstock Production Manager Mary Bradford Production Assistant Amy Chinn

Seattle Met Associate Publisher Alysse Bryson Advertising Sales Manager Ryan Fitzgerald

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One secret millions of couples share.

12 Beauty and the Beast Why good skin care can save your life.

Plus, the latest on adult acne.

Departments Cutting Edge: Advances in Medicine

5 Apps for wellness, new treatments for varicose veins, and the bad news about sitting.

Family Matters 16 Diet, or Disorder?

18 Our Babies, Our Selves

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Breast Bets

20 Building a New Bust 21 Caring for the Girls 21 Testing for Breast Cancer

Women’s Health Annual Volume 2, Issue 1 The Women’s Health Annual is a publication of SagaCity Media and is produced as a supplement to Seattle Met magazine. For advertising inquiries contact Ryan Fitzgerald at 206-4543032. For editorial inquiries contact Julie H. Case at 206-454-3028. All rights reserved.

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Features 8 Inconceivable

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Account Executives Nina Feldman, Lysa Hansen, Cameron McKinley, Sonny Morris, Grace Oppenheimer

Cutting Edge

W

an app a day keeps the dOC away BRITT SANDERS

if mobile health pioneers have their way your phone may soon help you manage your health.

By Michelle Goodman

Wo m e n ’ s H e a lt h A n n u a l 2 0 1 3

While it may be a couple of years before doctors nationwide start prescribing digital wellcare, a handful of health management apps are already scoring high with the medical community, and others are coming soon to a mobile phone near you.

Waiting to Be Filled WellDoc: In clinical trials, early versions of this FDA-cleared app (part of a larger self-management platform) helped diabetics reduce their blood-sugar levels when compared to their usual care alone. This tool will be available to patients by physician prescription later this year.

SpiroSmart: Good news for asthmatics and others with chronic lung ailments. University of Washington researchers are now testing SpiroSmart, an app that uses your phone’s microphone to measure lung function. The app could be available to consumers by 2015. now Ready for PickUp AliveCor Heart Monitor: This FDA-cleared mobile electrocardiogram monitor works with iPhones and became available to medical professionals in January, meaning your next heart-rhythm check could be done on your doctor’s phone.

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Cutting Edge Get fit: Fitbit’s tiny Zip activity tracker (fitbit.com; $59.95) records steps, distance, and calories burned, and syncs that data to your iOS device or Android phone. Track your progress with the free smartphone app, and use it to log activities and food.

Eat right: Fooducate (iOS, Android; free) “grades” food and drink labels based on their nutritional value. And Calorie Counter Pro (iOS, Android; $3.99) does exactly what it says.

Monitor blood pressure: The Withings Blood Pressure Monitor (withings.com; $129.95) with BP cuff sends data to your iOS device, where you can also track everything from sleep to weight to activity with Withings’s Health Mate app (iOS, Android; free).

Track glucose: For diabetics, the iBGStar blood-glucose meter (ibgstar.us; $71.99) connects with an iOS device to record blood sugar, insulin, and carbs, and lets you share that data with a doctor.

Check symptoms: iTriage (iOS, Android; free) lets you search by symptom for possible causes, and helps you find suitable treatments, doctors, or health-care facilities.

Find a doctor: ZocDoc (iOS, Android, BlackBerry; free) lets you search for doctors and dentists in your insurance network, read patient reviews, and book appointments on your phone.

Manage prescriptions: iPharmacy (iOS, Android; free) gives details on your medication, reminds you to take your pills, and lets you shop for the lowest prescription price. ■

NO LONGER IN VEIN new varicose treatments are good for the gams.

It seems unbelievable that in the age of stem cells and lab-grown organs, many doctors still treat severe varicose veins with circa1900s vein stripping. Luckily, two new vascular innovations—endo6

venous laser treatment (EVLT) and the radio frequency (RF) catheter—now make for flawless legs in the span of a lunch break.

Approved by the FDA in 2002 for use in this context, EVLT is a minimally invasive procedure that requires only local anesthesia and guarantees a 90-plus percent success rate in delaying the reemergence of varicose veins. A small catheter is inserted into the vein to place a laser fiber, which is then fired, damaging the vein wall and causing it to close. While a lingering dull burning sensation is often reported for a week or two following treatment, and light bruising is common, patients quickly return to daily activities.

On the other hand, patients working with an EVLT rival, the RF catheter, report very little postsurgery pain or bruising whatsoever. In this procedure, a small catheter is inserted into the diseased vein. As the catheter is slowly removed, it emits RF energy to heat up the collagen in the vein’s wall to seal it, allowing blood to redirect to healthy veins.

Dr. Michael Eickerman, a vascular surgeon at Puget Sound Vein Center, raves about the Covidien ClosureFast catheter—approved by the FDA in 2006—which has about a 93 percent three-year preventive success rate.

As superficial venous reflux is considered a serious medical condition, insurance usually covers both treatments (although to varying degrees), making it easier to stay off the operating table.

—Katie Vincent

when sitting kills spend all day in a chair and you’re 90 percent more likely to die of heart disease According to a study published in the journal Diabetologia in July 2012, those with excessive sitting habits—by some definitions a mere four hours a day—double their risk of developing diabetes and cardiovascular disease, increase their risk of dying from heart disease by 90 percent, and increase their risk of premature death from any cause by 49 percent. By comparison, smoking triples a middle-aged woman’s chance of dying from heart disease.

And while the numbers were slightly lower, a 2010 study, published in the American Journal of Epidemiology, of people who sat more than six hours and were minimally active in all aspects of leisure time showed the news is worse for women: Females who sat more than six hours daily showed a 34 percent increased risk of dying prematurely, while men had a 17 percent increase.

Why is sitting unhealthy? Dr. Emma Wilmot, research fellow in the Diabetes Research Group at the University of Leicester and lead researcher for the Diabetologia study, suspects sitting causes changes in postural muscles and in how fats and glucose are metabolized, changes which come with adverse health effects.

Both studies also show hitting the treadmill isn’t enough to counteract hours of sitting. To reduce risks one must actually sit less. Instead of e-mailing, walk to coworkers’ offices; stand up during phone calls; use a standing desk; and stretch while watching TV. Dr. Alpa Patel, epidemiologist at the American Cancer Society, and the 2010 study’s lead researcher, puts it this way: “I think (for me) the message has been that small steps can make a big difference in your health.” —Nancy Schatz Alton Wo m e n ’ s H e a lt h A n n u a l 2 0 1 3

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Inconceivable One secret millions of couples share.

Fertility. It’s the F-word people don’t say in public.

A whopping one in eight couples has trouble having children, yet it often seems like the story women tell most easily is how they got pregnant the first month they tried.

For most women—particularly healthy, active ones—being unable to have children easily can be a shock. “No one ever talks about what happens when it doesn’t work those first few months,” says Karen*, a 35-year-old Seattle native, who had a daughter with the help of in vitro fertilization (IVF).

Before she started trying to have kids (“trying—I hate that word!”

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Karen says), she knew people judged those who used fertility treatments to have a family. She did, too. When she’d read about celebrities having twins through in vitro fertilization, she felt like they were cheating. Her own mother always talked about how easily she and her siblings were conceived, and she assumed the same would be true for her.

But often, talking about fertility struggles can reveal how common they are. Karen spent six months charting her temperature to figure out when she was ovulating, and her own physician told her to relax.

Then, when a longtime friend asked Karen when she was going to have

children, Karen almost started to cry. The friend pulled her aside and told her that her own two kids had been conceived with the help of a fertility clinic.

And she wasn’t alone. According to the Centers for Disease Control and Prevention, more than 1 percent of the babies born each year are conceived with IVF and similar treatments.

Karen also thought infertility was a problem that older women had. Age can be a factor in fertility challenges, and more women are delaying pregnancy until their 30s and 40s. A 40-year-old woman might look so youthful she gets carded and be sprinting past

Wo m e n ’ s H e a lt h A n n u a l 2 0 1 3

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by cameron walker

younger runners in the Seattle Marathon. But on average, she has just a 5 percent chance of conceiving each month.

Younger women can have trouble conceiving, too. For couples that go through fertility testing the cause of infertility is almost evenly divided among female-factor problems, male-factor problems, and a mixture of both partners or undetermined reasons.

A range of options is available to address infertility. Fertility drugs, targeted to different aspects of conception, can be used alone or coupled with additional treatments. One of these treatments is intrauterine insemination (IUI), in which sperm—whether from a partner or a donor—is inserted directly into a woman’s uterus close to the time she is ovulating.

Depending on a woman’s health history, age, and other factors, these treatments’ effectiveness may vary. IUI can have a pregnancy rate of up to 20 percent for each menstrual cycle.

A woman may start with fertility drugs and IUI or, depending on her age and specific fertility challenges, may decide to move directly to assisted reproductive therapies, in which eggs are removed from a woman’s ovaries and combined with sperm in a laboratory. With in vitro fertilization, the most commonly used assisted reproductive therapy, a woman usually takes fertility drugs to encourage the body to produce more eggs; then eggs are retrieved from follicles in her ovaries in a minor surgical procedure.

If an embryo forms after the egg is inseminated with sperm, it is placed back in the woman’s uterus.

Embryos can also be frozen for future use.

IVF is more expensive and intensive than other treatments; in many cases, it also has higher success rates. In 2010 the Society for Assisted Reproductive Technology reported that, for women younger than 35 nationwide, about 40 percent of embryo transfers in a given cycle became new babies.

Usually, a woman’s own fresh or frozen eggs are implanted. But sometimes—whether because of Wo m e n ’ s H e a lt h A n n u a l 2 0 1 3

genetic conditions or advancing age—a woman uses donor eggs.

The CDC reports that in 2008 close to 12 percent of assisted reproductive technology cycles nationwide used eggs or embryos from donors. In 2011, two Seattle clinics performed a combined 494 IVF cycles using donor eggs—210 with frozen embryos and 284 with fresh. Live birth rates for the two clinics were roughly 32 and 49 percent using the thawed embryos, and 62 and 67 percent with fresh embryos.

No matter what route a woman takes to address infertility, treatments aren’t easy. To prepare, women give themselves injections—41-year-old Jennifer Johnson sometimes had to give herself six shots a day. The drugs are pricey; can send a woman on

A 40-yearold woman might look so youthful she gets carded. But on average, she has just a 5 percent chance of conceiving each month.

an emotional, hormone-induced roller coaster; and aren’t a guarantee. After Johnson’s first round of fertility drugs, she went to the clinic only to discover her body had made too few follicles from which eggs could be harvested.

“It was devastating—and expensive,” she says. She feels fortunate her husband’s insurance covers some of the cost of treatments, and that they can make up the rest—something she knows not everyone can afford.

The nationwide average cost of an IVF cycle is $12,400, according to the American Society of Reproductive Medicine; Johnson and other Seattle-area women pay more. Fertility clinics often offer financial assistance and payment plans. “Even so,” she says, “if I was making $30,000 a year, it wouldn’t be an option.”

Going into these treatments, a woman can be frustrated by not knowing her individual chance of becoming pregnant. “It’s all or nothing: you’re either pregnant or you’re not,” says Dr. Julie Lamb, a physician at Pacific Northwest Fertility and IVF Specialists in Seattle. Regardless of published success rates, a woman doesn’t know if a fertility treatment has worked for her each and every time, until she gets that positive pregnancy test.

And then there’s the worry that the stress itself is responsible for each cycle of IVF that passes without a pregnancy. Recent research might take this particular concern off of a couple’s plate: A 2011 study in the British Medical Journal found that stress did not play a role in the success of individual IVF cycles.

But dealing with the stress that infertility causes can only be helpful, Lamb says, whether through yoga, acupuncture, or counseling.

These techniques can prepare a person to deal with problems in other areas of their lives—and help to weather unexpected fertility challenges.

Finding others who are going through the same experiences can help. Some women take refuge in online support groups, including those through Resolve, the 9

national infertility association.

Others read blogs where people chronicle their journey through infertility. And even though Lynn Jensen’s weekly Seattle and Kirkland Yoga for Fertility classes are spent primarily in poses, not in conversation, women approach her after class to tell her how helpful it is to have “a whole roomful of women who understand what I’m going through,” says Jensen, who experienced fertility challenges herself.

Even if a woman becomes pregnant, infertility can color the experience. Misty, who was 32 when she started fertility treatments, went through several rounds of IVF before becoming pregnant with her first child. She lost two pregnancies along the way, including a twin pregnancy that terminated at different stages and ultimately ended in a D&C. “I’d already envisioned running with my double Bob stroller around Green Lake,” she says. Losing the second twin was particularly traumatic. “I felt like I was cursed. I was lying in the fetal position for days on end.”

What kept her going? The desire to have her own family.

“For me, I felt like there was no other way,” she says. She considered adoption, but thought it was more expensive and “just as much of an emotional roller coaster.”

A fourth round of IVF resulted in two embryos. One was implanted in her uterus, the other frozen. Misty says she was a basket case throughout her first pregnancy. And even after she had her daughter, her fertility challenges still haunted her. “When breastfeeding was going bad, I thought it was more evidence that I was a reproductive failure.”

About a year after her daughter was born, she went through another round of treatments using the frozen embryo. Pregnant again, she felt more confident because she’d been through it before—also a toddler kept her too busy to spend as much time worrying.

Here is the trouble with stories about infertility: It feels better to end with a successful treatment, 10

Other women who wish they had thought about their fertility when they were younger are urging friends in their 30s to freeze ’em while they got ’em. looking at a beautiful baby held in its parents’ arms. But sometimes that’s not what happens. After six months of IUI, Rebecca and her husband decided to put treatments on hold and revisit the idea in 2013; financially and emotionally, the treatments became too much. “We expected at the end of this, we would have a baby, and I think most people expect they will,” says Rebecca, 38, who has a preschooler conceived without fertility treatments. She wishes she’d prepared herself for the possibility that she might not have more children.

Other women wish they had thought about their fertility when they were younger.

Johnson would have had her eggs frozen in her early 30s, and advises younger women to do so.

“If you’re pushing your career and not pushing your relationship,”

she says, “you might go and get your eggs harvested, just in case.”

Statistics aren’t readily available for how many women freeze eggs for future use; until recently, the American Society for Reproductive Medicine considered it an experimental technique.

One of the things Lamb, at Pacific Northwest Fertility, suggests to her patients is always knowing their next step if the current strategy doesn’t seem to be working, whether it’s moving on to IVF, taking a break from treatments, or considering adoption.

“I’m convinced that everyone can build a family, and there are a lot of different ways to do it.”

That’s what Johnson is doing.

She plans to go through up to two more rounds of IVF treatments, and then reevaluate her options.

Sometimes the destination of the fertility journey isn’t exactly what a woman had envisioned.

When, after two miscarriages, Heather and her husband had tests done at a local fertility clinic, they learned she had a rare chromosomal abnormality called a balanced translocation. A genetic counselor told Heather she had a 5 to 10 percent chance of conceiving a baby with her own eggs.

Heather blamed her parents for not knowing about her genetics and felt sad that she’d never have a baby that shared her genes.

And still, they tried. After another miscarriage and a lot of soul-searching, the couple decided that they would use a donor egg, and that Heather would carry the embryo. Three embryos—from the donor’s eggs and Heather’s husband’s sperm—were frozen.

One didn’t thaw correctly; another resulted in a miscarriage.

Throughout the process, she says, “I learned that I’m stronger than I thought I was, and that I’m more open than I thought was.”

The third embryo implanted and Heather’s little boy was born—albeit prematurely—on January 8, 2013. ■ *Like many of the Seattle-area women who wanted to share their fertility struggles, Karen wanted to be identified only by her first name.

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Beauty and the Beast Why good skin care can save your life by christy k arr as

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s a teenage lifeguard, Nathalie Turner spent more time working on her tan than she did worrying about her skin. “Sun protection wasn’t promoted—suntanning was,” the 40-year-old Seattle resident says of the attitude back then. Now she’s finally starting to think about the consequences. “I worry about skin cancer because of my fair skin and my early years in the sun.”

Many of us are guilty of taking a blasé approach to skin care at one point or another, but the truth is that sun exposure can lead to serious health issues, including skin cancer. Melanoma (the most dangerous type of skin cancer) is the leading cancer killer of women between the ages of 25 and 30, according to the Melanoma Center.

The Pacific Northwest’s cloudy, overcast weather doesn’t offer a reprieve either. Washington had the eighth and 13th highest rates, respectively, for melanoma diagnoses and deaths in women when compared to other states.

“I find that some of my patients do seek out the sun at times because they feel deprived of the sun for much of the year,” says Dr. Sasha Kramer, president of the Washington State Dermatology Association. “I try and educate them that there is no such thing as a healthy tan and that a suntan actually repreWo m e n ’ s H e a lt h A n n u a l 2 0 1 3

sents damage to skin cells.”

Education, it turns out, is key. While the Food and Drug Administration has created new sunscreen labeling guidelines to set specific standards for water-resistance and sun-protection claims, it’s still up to the consumer to use the required amount.

“On average, Americans apply only a third as much sunscreen as the government thinks we do when they determine protective levels,” says Dr. Paul Nghiem, a dermatology professor and researcher at the University of Washington.

Besides applying, reapplying, and reapplying some more, you can boost your protection by choosing sunscreens with physical blockers, such as zinc oxide, which absorb light or deflect it away from the skin. There are also more appealing—and therefore more likely to be used—options out there, including sunblock powders and tinted lotions.

Other new, inventive ways to combat skin cancer are being researched in the lab. Nghiem has discovered that caffeine—the favorite drug of the Northwest—appears to kill precancerous or early-cancer cells. It’s most effective when cell damage first begins, so drinking a coffee while you lounge on the beach might not be a bad idea.

Other than guzzling that latte, your best defense for now is covering up in the sun, knowing what skin cancer looks like, and consulting a professional on a regular basis. “If you have a family history, you should start younger, just like people with breast cancer in their families,” says Dr. MinWei Christine Lee, a board-certified dermatologist and dermatologic

Even if you’re just sitting in your car, you get sun damage.

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surgeon in Walnut Creek, California.

She recommends that highrisk adults see a dermatologist every six months and that other adults—especially those with fair skin, light-colored eyes, and a history of sunburn—get checked annually.

Even if UV rays don’t lead to cancer, they can cause wrinkles, freckles, and blotches. “The more sun damage you’ve had, the faster you will age,” Lee says. “Even if you’re just sitting in your car, you get sun damage.”

Casey Kennedy often heads outside to watch her son play sports and has already started to see cosmetic effects. “My skin is starting to crepe in the areas where it was exposed to the sun all my life—arms, ankles, face a wee bit,” the Bellevue resident says. “I don’t have creping on other areas, so it’s obvious that the sun was the culprit.”

Luckily, there’s a multitude of ways to combat everything from crow’s-feet to age spots.

“As a baseline, women should use sunblock, a topical retinoid which regenerates the skin, and topical vitamin C, which is an antioxidant and decreases free radicals from sun exposure,” says Dr. Hayes B. Gladstone, a dermatologist at the Berman Gladstone Skin Institute in the San Francisco area.

Discoloration can also be treated with noninvasive laser or light therapy, sometimes combined with a topical chemical treatment. More in-depth treatments—laser resurfacing or chemical peels—handle both blotches and wrinkles, but they also increase skin sensitivity and require patients to stay out of the sun.

Other less intensive options include anti-aging creams with a hydroquinone-based bleaching agent. For former lifeguard Turner, the advice is plain and simple: “Wear sunscreen religiously, even in winter!” ■

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What Causes Adult Acne?

The answer is more than skin deep.

By Christy Karras There’s a volcanic eruption forming on your face, and you’ve just dressed for a charity ball: Wasn’t this acne thing supposed to end at 20? Or at least by 30?

According to the American Academy of Dermatology, 50 percent of women get acne at some point in adulthood—disproportionate to the rate of men.

Don’t blame chocolate, fatty foods, or heavy moisturizers; it’s more complicated than that. While increasing scientific evidence suggests foods with a high glycemic index and dairy products can make acne worse, says Dr. John Knox, adult acne also stems largely from things even harder to avoid: stress and hormonal changes.

Knox, a Swedish-affiliated dermatologist who practices at Minor & James Medical in Seattle, says there are three common types of acne he tends to see. The first is the teenage-era kind that can also flare up throughout adulthood, especially during stressful times and hormone changes.

The second type, acne rosacea, is associated with broken blood vessels and skin that flushes easily. Like rosacea in general, it is exacerbated by red wine, certain foods, and sun exposure. “My rosacea patients tend to be better at wearing sunscreen than my skin cancer patients” because their skin’s reaction is more immediate and visible, Knox says.

Then there’s perioral dermatitis, which causes a fine rash as well as pimples primarily around the mouth, including on the nose and chin. This type is even more stress related, comes on suddenly, and almost exclusively affects middleaged women.

The skin creams that work on teenage acne are too strong for most adult acne.

They can cause excessive irritation and don’t address its underlying causes. “Adult skin is very different from teenage skin. You have to be much more aware of what can irritate the skin,” Knox says.

Fight the temptation to scrub acne-prone skin. The American Academy of Dermatology recommends washing with lukewarm water and using mild cleanser in the morning, evening, and after sweating.

After all, says Dr. Nicola Nylander, a dermatologist with the Polyclinic, adult acne isn’t just about how clean you keep your skin. “It’s about hormones. Babies get it— both male and female—and it comes from the mother during birth, then disappears quickly. Teens get it, naturally. Then, adult women are prone to acne, too, much more so than men. That’s because our hormones are changing regularly— on a monthly basis—in a way that men’s don’t,” Nylander says. “Oral medication—not just topical solutions—may be needed to treat adult onset acne.”

Most important, Knox recommends dealing with the underlying causes of adult acne, including stress.

That means trying known stress reducers such as yoga and, he adds, “avoiding mean people.”

The bottom line: Treating acne means being gentle on your skin—and on yourself.

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Family Matters

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diagnosing the many faces of eating disorders

By Sarah DeWeerdt

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Twenty million American women have suffered from an eating disorder at some point in their life. These diseases are technically mental-health issues, but the physical consequences can be profound. Poor nutrition starves the body and can lead to heart irregularities and kidney problems.

“The rate of mortality among young women with eating disorders is much higher than any other mental illness,” says psychiatrist Dr. Mehri Moore, founder and medical director of the Moore Center, an eating disorders treatment facility in Bellevue.

Historically, the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) has officially recognized two types Wo m e n ’ s H e a lt h A n n u a l 2 0 1 3

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Family Matters of eating disorders: anorexia nervosa, characterized by severe food intake restriction and an intense fear of gaining weight, and bulimia, which involves bingeing on large amounts of food and then vomiting, abusing laxatives, or overexercising.

A third type, binge eating disorder, appears in the new edition of the DSM, released in May. Those with binge eating disorder eat abnormally large amounts of food in a short period of time and feel a lack of control over their binges, but don’t engage in purging behaviors like bulimics.

Those suffering from eating disorders come in all shapes and sizes. Anorexics are often extremely thin (a refusal to maintain at least 85 percent normal body weight is one diagnostic criterion), bulimics are typically average weight, and binge eaters are often overweight or obese.

That means the most reliable warning signs are behavioral, such as compulsively reading labels, counting calories, being obsessed with or inflexible around food, and refusing to eat in front of others.

Treatment for an eating disorder typically involves a team of professionals, including a dietitian, therapist, psychiatrist, and family physician. Some treatment programs also incorporate new approaches such as yoga, which allows relaxation, mindfulness, and body awareness that can help eating disorder sufferers realign their disordered thoughts and behaviors related to food.

Researchers at Seattle Children’s Hospital found that teens who participated in an eight-week yoga program in addition to standard treatment had fewer eating disorder symptoms several weeks after the program ended, compared to those who received standard care alone.

Recovery is definitely achievable, but because so many women battle eating disorders for decades, it can take a long time to get to that point. All the more reason to know the warning signs and seek help as soon as possible. ■ 18

OUR BABIES, OUR SELVES Giving birth may have lasting health benefits for Mom. A pregnant woman does many things to keep her growing baby healthy, from changing her eating habits to exercising. Now researchers are starting to discover that the baby has a long-lasting effect on its mother’s health, too.

Fetal cells cross through the placenta, moving into the mother’s body during pregnancy. In cases of pregnant women who had appendectomies, cells from their yet-to-be-born children turned up in the removed appendix, potential evidence that the cells are affecting the tissue. Once the baby is born, these cells can remain with the mother for decades. Fetal cells may be able to form new tissues and even help repair organs, says Dr. J. Lee Nelson, an autoimmunity researcher and rheumatologist at Fred Hutchinson Cancer Research Center.

These cells might also affect a woman’s susceptibility to disease.

Nelson has been studying how fetal cells might affect a mother’s susceptibility to autoimmune diseases. Already known is the fact that during pregnancy, women with rheumatoid arthritis (RA) often notice symptoms vanishing. Nelson and her colleagues also found that mothers were almost 40 percent less likely to get RA than childless women. And cells passed from baby-to-be to mother might play a protective role in other diseases, too. In several studies, researchers have demonstrated that women who carry fetal DNA—which is found by looking for the male Y chromosome (simply because it’s easier to pinpoint than fetal female X chromosomes)—have a lower risk of breast cancer than those who don’t bear children.

Sometimes, though, cells from baby-to-be can make a woman more susceptible to certain types of disease. One is scleroderma, which affects connective tissue, with fetal cells being found in the skin and tissue of women who suffer from it. In a 2012 study, researchers also found that women with the highest levels of fetal cells in their circulating blood were four times more likely to develop colon cancer. The result was a surprise, says Dr. V. K. Gadi, the study’s senior author and a medical oncologist at Fred Hutchinson Cancer Research Center, and points to the difference in breast and colon cancer development, acknowledging that foreign cells could be driving an inflammatory response that contributes to colon cancer.

Now researchers are interested in finding out exactly how fetal cells affect a mother in order to develop new therapies—making use of the cells’ protective qualities or blocking the harmful attributes they bring.

And, says Gadi, if a woman’s fetal-cell level were factored into her breast cancer risk calculation, physicians could be able to know who might benefit the most from diagnostic preventive tests.

All of which means our cells aren’t just our own, but a connection to our past, our future, and our health. Or, as Nelson puts it: “We should really begin with a different concept of what the biological self is.”

—Cameron Walker

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F

building a new bust breast reconstruction has come a long way, baby.

By Diane Mapes

20

Forget your old notions about breast reconstruction after a mastectomy. Thanks to a new method, what was once a long and arduous endeavor requiring multiple surgeries, protracted recovery time and, for some, complications such as implant hardening can now be a scalpel-free process with little recovery time.

Brava, pioneered by Miami plastic surgeon Dr. Roger Khouri, uses liposuction to transfer fat from a woman’s hips, thighs, or stomach to her breast area, which is prepped for the process with a large suctioncup bra (also called Brava) that expands external skin, loosens scars, and creates a small pocket and new blood vessels. Once that pocket is created, the surgeon fills it with tiny injections of fat from the stomach, hips, thighs, etc., which then feed off the newly created blood vessels.

“I consider it a potential breakthrough,” says Dr. Frank Isik of the Polyclinc in Seattle—who has more than 15 years of breast reconstruction experience using traditional methods such as tissue expanders, implants, and “flap” procedures, which harvest tissue and/or muscle from a woman’s stomach or back to surgically create new breasts, and has worked with 10 patients using Brava. “It’s a very natural reconstrucWo m e n ’ s H e a lt h A n n u a l 2 0 1 3

BRITT SANDERS

Breast Bets

Breast Bets tive method, and the recovery period is nowhere near as lengthy as the other methods. Plus it isn’t as invasive, doesn’t have extensive scars, and there’s not a long recovery period.”

Along with more realistic feeling breasts, Brava’s benefits include body-contouring results from the liposuction and, according to three of Isik’s patients, more sensation.

“The real minus with it is the onerous aspect of wearing the [Brava] device,” Isik says. “It’s cumbersome, it causes rashes, and patients need to wear it for several weeks before and after each procedure.”

Patients opting for this type of fat-transfer reconstruction also have to undergo at least three procedures to get an A or B cup breast. A small C cup might require up to four or five sessions.

While reserved about the new procedure at first, Isik is now offering it to all qualifying breast reconstruction patients by enrolling them in an ongoing clinical

MIKEL HEALEY

Testing for Breast Cancer Most women know the importance of selfexams, mammograms, and other screening methods when it comes to the early detection of breast cancers. Now there’s a new test that can tell women if they’re at risk even before they develop the disease (as one in eight US women do).

Phenogen Sciences, Inc’s BREVAGen DNA test requires a simple cheek swab. It examines seven genetic markers known as SNPs—single nucleotide polymorphisms—and also considers factors such as a woman’s age, her ages at her first period and first live birth, family incidence of breast cancer, lifetime exposure to estrogen, and race and ethnicity.

Results include a five-year and a lifetime risk assessment. While the test doesn’t diagnose breast cancer or tell women if they carry the gene—as BRCA tests do—it can tell a woman her risk of developing certain types of the disease, particularly estrogen-receptor-positive cancers, which make up 50 to 70 percent of all breast cancers.

Wo m e n ’ s H e a lt h A n n u a l 2 0 1 3

trial, and two surgeons at the Plastic and Reconstructive Surgery Clinic at the UW Medical Center are performing this type of reconstruction, as well.

For women who prefer more traditional reconstruction—or for those interested in breast enhancement—Isik says the latest advancement is cohesive gel implants, also known as “gummy bear” implants.

“Currently, implants are silicone gel,” he says. “There’s a hard membrane on the outside but more of a gelatinous nature—like Jell-O—on the inside. If the outer membrane does rupture, it stays together but it is fluid.”

These new “gummy bear” models, however, are more stable.

“They are far less likely to rupture, and if they are ruptured, they are far less likely to distort their shape,” Isik says. “We think this is a significant improvement over the current technology in silicone implants, but results of ongoing clinical studies will demonstrate their benefits.” ■

“The BRCA1 and BRCA2 test is for estrogen-receptor-negative cancers, but more than half of the cancers are estrogen-receptor-positive,” says Dr. Lisa Steffensen, a family physician with Primary Care Associates in Bellevue, who also regularly administers BREVAGen. “This is a wonderful way to screen for a majority of the breast cancers.”

Steffensen adds that women with a high lifetime or five-year risk can work to make preventive changes in diet (she swears by turmeric), exercise, alcohol consumption, and weight. Or they can opt for additional screenings. “Some women may want to have MRIs done, which could catch cancer earlier than a mammogram,” Steffensen says.

BREVAGen can also be helpful for women trying to decide whether to have hormone replacement therapy. “If a woman tests positive, estrogen would be like Miracle-Gro and feed tumor sites, so I wouldn’t recommend it,” Steffensen notes.

Some insurance plans cover the test, and a “patient protection program” limits the out-of-pocket cost to $250 regardless of insurance. —DM

caring for the girls

by Diane Mapes When it comes to breast practices, not every woman knows what’s best.

Enter Elisabeth Dale, author of Boobs: A Guide to Your Girls and founder of the TheBreastLife.com. Here’s her sage advice on keeping breasts firm and fetching.

Get sporty “You want a sports bra that has separate compartments for each breast,” says Dale. “Women’s breasts don’t just move up and down and side to side. They move in a figure eight.

You want to contain that.”

Moisturize Put sunscreen on the décolletage.

“Expose skin, and you’re going to go from cleavage to ‘creaseage’ a lot quicker,” she says. “Moisturize your boobs and keep sunscreen on them at all times. That whole area is delicate.”

Don’t smoke “Smoking has been shown to cause sagging breasts.” In fact, smoking causes sagging of all the skin of your body.

Stand straight “A lot of times women won’t stand up straight, so they look more saggy than they are.” Dale suggests focusing on posture and building pectoral and arm muscles.

Watch weight It’s not about being super thin, but about avoiding frequent weight changes.

“Yo-yo weight gain and loss can affect the elasticity of your skin.” And you may lose your boobs and not get the fat back in the same place.

Splurge Many of us buy lingerie only for a new relationship.

Change that. “If you’re wearing something amazing under your clothes, you’re going to feel like a rock star,” she says.

21

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