March 2009 Mayo Clinic Women’s HealthSource Highlights Molecular Breast Imaging, Canes and Walkers, Training for an Event and Hormone Therapy for Women
Molecular Breast Imaging: A Better Way to Spot Tumors in Dense Tissue
MBI overcomes a shortcoming of mammography, which is taken with X-rays. The X-ray imagery doesn’t differentiate between tumors and dense breast tissue. On a mammogram, they both appear white.
“With MBI, a tumor is easy to see, even if it’s in dense breast tissue,” says Dr. Rhodes.
Here’s why: With MBI, a woman is given an injection of a short-lived radioactive agent. This material accumulates in tumor cells more than it does in normal cells. Using a radiation-detecting camera, tumors show up as hot spots on the resulting image.
In a recent Mayo Clinic study comparing MBI with mammography, MBI detected three times as many cancers in women with dense breast tissue and an increased risk of breast cancer. Another advantage over mammography: MBI also demonstrated fewer false positives, meaning the results appear abnormal but are noncancerous.
For now, MBI use is limited to research. The focus is to reduce the dose of radiation needed to perform MBI. The risk from the radiation dose of one or two MBI scans is extremely low. But to safely use MBI annually or every few years, the radiation dose needs to be reduced.
“Our goal is to have a dose that’s no higher than that from a routine mammogram,” says Dr. Rhodes. “If we get results that are similar to, or better than, our last study, we’ll be well on our way to supporting MBI as an option for women with dense breast tissue.”
Canes, Walkers: These Tools Are Made for Walking
The March issue of Mayo Clinic Women’s HealthSource offers tips for selecting and using canes and walkers:
Canes: Canes provide balance and support for walking, handling up to 25 percent of their body weight. Many types of canes are available. Aluminum ones are adjustable; wooden canes must be cut to fit. For everyday use, a hooked, or candy cane-style, cane probably won’t be the most comfortable. A swan neck handle, which is flatter and puts the user’s weight directly over the cane’s shaft, likely will feel better.
For appropriate fit, the top of the cane should reach the crease of the wrist when the user is standing up straight with arms hanging comfortably. Using a cane that’s too long puts strain on the arms, shoulders and back muscles. Too short, a cane throws off balance.
Normally, a cane is held in the hand opposite of the weaker side. With weight on the stronger leg, the cane and the weak leg swing and strike the ground at the same time. When a cane is needed primarily for stability, it can be held in either hand.
Walkers: Walkers provide a wider base of support and stability for balance and walking than do canes. Walkers, which can support up to 50 percent of the body weight, are especially helpful for moderately severe balance and gait problems, or when there’s a risk of falling.
Walkers are available with two, four or no wheels. Two is best when the user places a moderate amount of weight on the walker. The legs without wheels help prevent the walker from rolling away. For those who don’t have to lean on the walker, four wheels may make it easier to move about. A standard walker — no wheels — provides the most stability.
For fit, the top of the walker should come to the crease in the wrist when standing straight up with arms at the sides. A poorly fitted walker can be difficult to use, causing back pain or, worse, increased risk of falling.
Canes and walkers are available at medical supply stores, drugstores and discount retailers. It’s a good idea to try several styles before making a decision. In most cases, at least some of the cost of assistive devices is reimbursed through Medicare and other insurers.
Adapting to a cane or walker takes time and may require a shift in self-concept. Attitude about the device — as a help not a hindrance — can be as important as the device itself.
Training for an Event: A Carrot to Keep Exercising
Event training can be an incentive to meet exercise and fitness goals, according to the March issue of Mayo Clinic Women’s HealthSource. In addition, many women find participating in a community fitness event provides a sense of camaraderie, purpose and achievement. (And, there’s likely a souvenir T-shirt in the deal, too!)
Most communities have frequent fitness events, sponsored by charities, businesses or health organizations. They range from short-distance walks and runs to endurance events such as marathons and long-distance bike rides.
Consider these tips to help select and prepare for a community fitness event:
Assess personal fitness level: Even if you are a regular exerciser, you may need to add workouts to the weekly schedule to prepare for a challenging event. If exercise is new, especially for those with a medical condition, women over age 55 and men over age 45, it’s wise to talk with a doctor before beginning a training program.
Get the right gear: A supportive, well-fitting pair of shoes is essential. Find a store where staff is trained in fitting athletic shoes. Clothes should be appropriate for the sport and event.
Set a schedule: For a walkathon, it may be as simple as walking 30 minutes three to five times a week. Most community events offer sample training schedules to help prepare.
Work with a team, event support system or coaches: Some events offer group training and support.
Don’t overdue it: Set reasonable goals and build up gradually to avoid injury. Warm up and cool down before and after workouts. Include rest days in the training program.
Back off if you’re hurt: If you feel more than mild muscle soreness, take a break. If you are injured or feel pain, rest, use ice or check with a doctor.
Eat well and drink plenty of fluids: Emphasize healthy foods that pack the most nutrients for the calories, including fresh fruit, vegetables, lean meats, nuts, whole grains and low-fat dairy products.
Enjoy yourself: Part of the motivation for participating in an event is to have fun.
Hormone Therapy for Women: Neither All Good or All Bad
The Special Report covers the history of this therapy, risks and benefits, current uses, hormone substitutes, alternative therapies and new directions in treatment and research.
Among the report’s highlights:
A history of good and bad: In the 1980s and 1990s, doctors freely prescribed hormone therapy to relieve menopause systems and to help prevent heart disease and osteoporosis. In 2002, a large study called the Women’s Health Initiative (WHI) found that older women taking estrogen plus a synthetic form of progesterone (progestin) had a small but increased risk of heart disease, stroke, breast cancer and blood clots. Because of this research, many women discontinued hormone therapy.
Still effective for menopause symptom relief: Hormone therapy remains one of the most effective treatments for severe menopausal symptoms. Most experts consider it a safe and reasonable option for women with troublesome symptoms.
Dosage and delivery methods to reduce risks: Doctors now advise using the lowest effective dose for the shortest amount of time to manage symptoms and minimize risk. Several drug delivery options other than pills may be effective and safer. For example, direct application of a very low dose of estrogen cream can relieve vaginal dryness while minimizing widespread side effects.
Age might matter: Although estrogen therapy is no longer recommended to prevent serious conditions such as heart disease, there’s some evidence that it may offer benefits for women who take it early in menopause. In a secondary analysis of WHI trials, women between the ages of 50 and 59 who took estrogen and progestin or estrogen alone had no increased risk of heart attack. And, it appears that women who started hormone therapy within 10 years of menopause tended to have a reduced risk of heart disease.
Be wary of “safe” substitutes: Bioidentical hormones are made from plant sources and once processed, are chemically identical to hormones made in the body. They have been promoted as safer and more effective than traditional hormone therapy. However, with no evidence that this is true, it should be assumed that bioidentical hormones have the same risks as conventional hormone therapy.
No “one size fits all:” With hormone therapy, there is no single approach that’s right for all women. It takes a conversation with a doctor to discuss personal health history, potential risks and benefits and other treatment options to determine if hormone therapy is the right choice.
Mayo Clinic Women’s HealthSource is published monthly to help women enjoy healthier, more productive lives. Revenue from subscriptions is used to support medical research at Mayo Clinic. To subscribe, please call 800-876-8633, extension 9751, or visit www.bookstore.mayoclinic.com.
SOURCE Mayo Clinic