I was honored with an award at the annual luncheon of the Magnolia Council this week. (The Council consists of a fabulous group of women who support and foster the Tower Cancer Research Foundation (TCRF).) The foundation awards research grants, conducts clinical trials, supports and educates patients and most importantly humanizes care for cancer patients and their families. The doctors at Tower Oncology have always been the “go-to” referrals for most of my patients who have been diagnosed with cancer. So I was truly delighted to receive the award. Indeed, many of my patients came…and to those who were there and are reading my newsletter this week: Thank you!

There is, however, no “free’ award…The organizers of the luncheon asked me to give a brief talk on women’s health. Brief being 10 minutes; nearly the same time it takes to become calm, cool and collected after a hot flash. So in order to increase audience participation, I requested that the executive director read the following statements and then asked the 500+ women (and a few men) to raise their hands if they thought these statements ware true, or false. Here they are with just a brief explanation for each:

I need a Pap smear every year.
(False) To know why, you can review the full article I wrote titled “More Information on those Ubiquitous HPV Infections”. But if you don’t want to take the trouble to go back and review it (I know it’s sort of like homework), remember that cervical cancer is caused by HPV and hence is a sexually transmitted disease. It takes years for high-risk human papilloma viruses to enter the nuclei of cervical cells and cause the mutations that lead to cancer.. So we (the doctors) don’t start doing Pap smears on young women until they are 21 years old. After 21 (if normal), the Pap should be repeated every 2 years until the age of 30 at which time Pap and co-testing with HPV testing should be done. If both these tests are negative and a woman is in a mutually monogamous sexual relationship, she needs a Pap smear just every 3 years. And the current recommendations are that a Pap smear is not needed beyond the age of 65 or 70 as long as screening has been normal for the past 10 years and there have been no new partners that could possibly cause an HPV exposure. Moreover, if a woman has had a hysterectomy with removal of the cervix for non -cancer reasons, she does not need a Pap smear.

BUT (and this is very important), if a woman is high risk: i.e. is HIV positive, has had high risk HPV infections, pre-cancer or cancer of the cervix, or was DES exposed, then Pap smears have to be repeated annually and in some cases every 6 months. I know that many women confuse the gyne visit with “I need my Pap smear”. You still need to have regular gynecologic exams with or without a Pap smear; it will include a breast exam, pelvic exam, and discussion of contraception, fertility, cycles, hormonal issues, and general women’s health issues.

I should drink 8 glasses of water every day to stay healthy.
(False) We don’t know where this “rule” came from…it won’t make your skin dewier and it won’t make you thinner. Your body has a marvelous mechanism to maintain your fluid intake …it’s called thirst. If you are constantly drinking water and your kidneys are working properly, you will constantly fill your bladder and have to go. Your bladder may be overactive because your water intake is excessive. And if you overload what your kidneys are capable of “handling” you may cause an electrolyte imbalance. Remember everything you eat and drink has water, so you are already accessing fluids for your body with every bite and sip. Having said this, I will give a caveat or two: increase your water intake if you exercise rigorously or if you are in a very hot climate. (Obviously, I am not selling decorative shoulder straps for quart sized designer water bottles.)

C -section is the safest way to have a baby.
(False, probably)… especially if mom wants more children. Of course if the size of the baby or its position before birth poses a problem or if maternal conditions make labor and vaginal delivery unsafe, or if there is fetal distress, a C-section may be very necessary (and safest for mom and baby). I don’t want to downplay decision making by a well-trained obstetrician or midwife…that’s what my training was all about. But elective C -sections may mandate repeat C-sections with potential side effects for the mother and baby. (Here I do refer you to my article last week “Too Many or Too Few C-Sections?”)

If I take calcium and Vitamin D my bones should be fine
(Not necessarily) You have a chance to build bone until your late 20′s. Your bone filling cells are active and outpace your bone drilling cells when you are young. (Remember bone is a living tissue and not static, so there is always turn around which consists of cells that , like “Pac Men” create microscopic holes in the bone (osteoclasts) and those cavities are filled by bone filling cells (osteoblasts). After 30, the drilling begins to outpace the filling. So if you haven’t started with a good bone base to stand on (literally), it will get weaker with time. We lose about ½% of our bone density a year with age and 2% a year for up to 7 years once we no longer have estrogen (after menopause).

There is no question that calcium is essential for bone strength. We lose about 1000mg of calcium a day through excretion, sweating and general activities. If we don’t intake the calcium our body loses it gets it from our calcium storehouse…our bones. And Vitamin D is needed to help absorb and utilize the calcium we consume. So yes, we need it…for most adults the amount should be 1200 mg. a day and we should also get 600 to 1000 units of vitamin D. But we can’t always rely on this alone to guarantee bone strength. Bouts of low estrogen when we were young (irregular periods), a lifelong dietary deficit of calcium, diseases such as rheumatoid arthritis, medications (especially steroids), and family history of osteoporosis may all contribute to poor bone density. Indeed 50% of women over the age of 50 will suffer an osteoporotic fracture in their lifetimes. So discuss this with your doctor and if you are at risk or you have reached the age of 65, get a bone density test. If your bone density is low, and a calculation called FRAX (you can download this) shows you are at significant risk for fracture, you may need to start medication to prevent continued bone loss or even reverse it.

I went through several other statements during my presentation….and will share them with you in future newsletters. It seems that it takes longer to write my answers than to present them at a luncheon.