Mammograms: Making Sense of Conflicting News

In the past few months there’s been a lot of conflicting information about mammograms in the press. Not surprisingly, we get asked a lot of questions by our patients: Are mammograms useful? At what age should I start getting tested? What are the risks? What if I test positive?

Recent News: A Quick Summary

A few months ago, there was a cost analysis of whether women should start regular mammograms starting at age 40 or age 50. Why was this a concern? Because the American Cancer Society recommends that women start mammogram screening every year starting when they turn 40, while the U.S. Preventive Service’s Task Force recommends that women get a mammogram every other year starting at age 50.

A few weeks later, a Canadian study reported that mammograms did not reduce breast cancer deaths. This study was criticized by U.S. radiologists as being flawed and misleading.

The Latest Word

Even more recently, the American Medical Association published the results of studies that attempted to put all the previous research into perspective. For the first study, researchers at Harvard examined all the research done on mammograms since 1960. They concluded that while mammograms have benefits, these benefits have been “oversold,” while the potential harms have been minimized.

Who Should Get Screened, And When?

The researchers also found that annual mammograms can reduce the risk of dying from breast cancer by about 19 percent; but the benefit varies based on a woman’s age and her underlying cancer risk. For example, breast cancer becomes much more common as a woman ages. Here are the statistics:

chart

As for women age 75 and older, the study found that there have been no tests to see whether women of this age benefit from regular mammograms. This means that there’s no way to know how much regular mammograms might extend the life of a woman in this age range.

The Risk of Overdiagnosis

The Harvard study also evaluated overdiagnosis, in which women are treated for a cancer that would never have been life-threatening. The researchers found that about 19 percent of women who are diagnosed with breast cancer as a result of a mammogram undergo unnecessary surgery, chemotherapy or radiation.

So What’s the Bottom Line?

The researchers concluded that mammography is a useful but not perfect screening test. So if you’re trying to make a decision about mammography, be sure to discuss the risks, benefits, uncertainties, alternatives, and your own health history and preferences.

About the practice

Dr. John Garofalo, M.D., is a gynecologist located in Fairfield County, Connecticut. He has more than 20 years of practice and surgical experience covering many facets of obstetrics and gynecology.

Laury Berwitt is a nurse practitioner specializing in women’s health in Fairfield County, Connecticut. Laury has a passion for providing quality women’s health care in a safe and comfortable manner by creating a trusting patient-practitioner relationship. She has been in practice for 10 years, caring for women of all ages.

Laury and Dr. Garofalo offer mammography and related consultation services as part of well woman care.

For more information, go to www.garofaloobyn.com. John Garofalo, MD and Laury Berkwitt, APRN can be reached for personal consultations by calling 203.803.1098.

Vaccines During Pregnancy: Are They Safe?

There’s been a lot of conflicting information lately about vaccines during pregnancy. And not surprisingly, we hear a lot of questions on this topic at our medical practice. The short answer to the “are vaccines safe” question is that certain vaccines are strongly recommended during pregnancy, and that the known benefits of these vaccines are generally believed to outweigh any potential concerns.

Here are a few of the more common questions we’ve heard, along with our answers.

What is a vaccine and how does it work?

Most vaccines are solutions that contain a weakened, killed or similar version of a virus or organism that causes a particular disease. Vaccines take advantage of the fact that immune systems can “remember” infectious organisms and viruses.

Vaccines are generally injected into the deltoid muscle (the outer part of the upper arm). Vaccines are formulated so that they cannot get you sick, but they can prepare your immune system to fight that particular disease. In other words, vaccination can provide immunity without you having to experience the disease or its symptoms.

Should pregnant women get vaccinated?

Certain vaccinations can protect you from various infections and illnesses during and even after pregnancy. This protection is passed to your unborn child, helping to protect your child during pregnancy and even for the first few months after birth. This is particularly important for infections such as pertussis (whooping cough), which is highly contagious and can be particularly deadly for unborn newborn children and infants.  Vaccinations can also protect you from getting a serious disease that could affect future pregnancies.

However, not all vaccinations are safe during pregnancy. Vaccines that should generally be avoided during pregnancy include:

  • Varicella (chickenpox)
  • Human papillomavirus (HPV)
  • Measles
  • Mumps
  • Rubella

In addition, vaccines that contain weakened but live viruses — such as the nasal spray vaccine — are generally avoided for pregnant women (although they are considered safe for postpartum or breastfeeding women). Instead, pregnant women are usually given vaccines that contain inactivated (killed) or synthetic versions of the virus or infection-causing agent.

Your healthcare provider can help explain the vaccinations you should consider before, during and after your pregnancy.

Should pregnant women get a seasonal flu vaccine?

Inactivated seasonal and H1N1 influenza “flu” vaccines are recommended for most pregnant women. Pregnant women have a higher risk for serious complications from influenza than non-pregnant women of reproductive age. Flu  vaccine can protect pregnant women and their unborn babies, and also protect the baby after birth. In fact, the Centers for Disease Control and Prevention ¬— a federal agency that protects public health and safety through the control and prevention of disease, injury and disability — classifies pregnant women as a group that is more eligible to receive flu vaccines when the vaccine is in short supply.

What vaccines are safe during pregnancy?

Other than flu vaccines, the only vaccines recommended for routine use during pregnancy are primary or booster Tdap (tetanus, diphtheria and acellular pertussis) vaccinations. One dose of Tdap vaccine is recommended during each pregnancy, regardless of when you had your last Tdap or tetanus-diphtheria (Td) vaccination.

If you’re traveling abroad or if you’re at increased risk of certain infections, your healthcare provider may recommend other vaccines during pregnancy, such as hepatitis A, hepatitis B and meningococcal or pneumococcal vaccines.

When during my pregnancy should I be vaccinated?

Ideally, all women who are pregnant or might be pregnant during the influenza season should receive the inactivated influenza vaccine in October or the first half of November (prior to the influenza season), regardless of their stage of pregnancy. Vaccination after this period can still be beneficial because peak influenza activity usually occurs in January or February, but may occur as late as May.

Other immunizations during pregnancy may be delayed until the second or third trimester, to minimize concerns about complications. However, certain routine immunizations such as tetanus vaccines may be given during the first trimester if there are special risks to the unimmunized pregnant woman, fetus, or newborn.

Can a vaccine when I’m pregnant cause my child to become autistic?

Some researchers claim a connection between autism and childhood vaccines —particularly measles vaccine and thimerosal, a mercury preservative used in vaccines. However, the overwhelming majority of evidence does not support an association between immunizations and autism. The Advisory Committee on Immunization Practices (ACIP) does not recommend avoidance of thimerosal-containing vaccines for any group, including pregnant women.

Additional information on vaccines

Extensive information on vaccines and immunization can be found at:
www.immunizationforwomen.org
www.cdc.gov/vaccines
www.cdc.gov/vaccines/pubs/ACIP-list.htm

About the practice

Dr. John Garofalo, M.D., is a gynecologist located in Fairfield County, Connecticut. He has more than 20 years of practice and surgical experience covering many facets of obstetrics and gynecology.

Laury Berwitt is a nurse practitioner specializing in women’s health in Fairfield County, Connecticut. Laury has a passion for providing quality women’s health care in a safe and comfortable manner by creating a trusting patient-practitioner relationship. She has been in practice for 10 years, caring for women of all ages.

Laury and Dr. Garofalo offer and wholeheartedly recommend influenza and Tdap vaccinations during pregnancy.

For more information, go to www.garofaloobyn.com. John Garofalo, MD and Laury Berkwitt, APRN can be reached for personal consultations by calling 203.803.1098.

 

da Vinci Surgery In The News: How Safe Is It?

A few days ago, I saw a local newspaper article that described a botched robotic surgery from 2009. The article went on to claim that new surgical technologies such as the da Vinci® Surgical System are not always properly evaluated by physicians and hospitals in terms of their potential harm to patients. Perhaps most alarming, the article noted that there are questions about the experience and expertise of many of the surgeons who use the equipment.

I always encourage my patients to be fully informed about the advantages and potential risks of any procedure they’re considering. From my perspective, the recent media coverage provides an excellent opportunity to explain robotic surgery and review what you can do to help prevent the kind of complications mentioned in the article. Finally, at the end of this blog you’ll find a description of my practice and what my patients can expect if they choose robotic surgery.

What is the da Vinci Surgical System?

As I explain on my website, the da Vinci Surgical System uses small incisions to allow surgical access for miniaturized surgical instruments and a high-definition 3D camera. Seated at a da Vinci console, the surgeon views a magnified, high-resolution 3D image of the surgical site. State-of-the-art computer technologies convert the surgeon’s hand movements into precise micro-movements of the da Vinci instruments. Introduced more than five years ago, the da Vinci Surgical System has been used successfully in tens of thousands of procedures.

As a minimally invasive technique, robotic surgery typically offers the benefits of less pain and bleeding, faster recovery and fewer potential complications compared to traditional “open” surgery. It also allows higher levels of precision and complexity than non-robotic laparoscopic procedures. However, as with any kind of surgical treatment, there are risks associated with robotic surgery. These risks include injury to tissues or organs; bleeding; infection, and internal scarring.

Questions for you to ask before you agree to robotic surgery:

COEMIG certification?
If you’re considering any gynecologic surgery, including one that uses robotic technology, be sure to ask if your surgeon and his or her hospital are COEMIG-certified. COEMIG stands for “Center of Excellence in Minimally Invasive Gynecology.” According to the American Association of Gynecologic Laparoscopists (AAGL), which created the COEMIG program, COEMIG certification is only given to surgeons and facilities that uphold an “unparalleled commitment and ability to consistently deliver safe, effective, evidence-based care.” COEMIG standards are frequently upgraded as surgical processes improve. Certification is not merely a one-time achievement; it must be maintained. Designees are regularly monitored by a special medical review agency.

Experience with robotic and laparoscopic surgery?
If you’re considering gyn surgery, be sure that your surgeon is not only COMIEG-certified but highly experienced in laparoscopic and robotic surgery. Remember that a surgeon cannot safely go from “open” hysterectomy to complex robotic surgery overnight. So ask: How much experience does your surgeon and his or her hospital have with robotic surgery? How many years of experience and how many surgeries? Likewise, how much experience does the surgeon have with non-robotic laparoscopic surgery? What is the surgeon’s record of successes and complications from robotic surgeries?

Don’t be afraid to speak up and ask. These questions can help reduce surgical risks while providing reassurance that your provider and healthcare facility are committed to your health and safety.

About Dr. John Garofalo, M.D.

Dr. John Garofalo, M.D., is a gynecologist located in Fairfield County, Connecticut. Dr. Garofalo was the first gynecologist in lower Fairfield County to be certified on the da Vinci Surgical System more than four years ago. He has performed hundreds of procedures with the da Vinci Surgical System, with a complication rate of less than 1%. He also has more than 10 years of experience performing complex non-robotic laparoscopic surgeries.

Dr. Garofalo is certified to use the da Vinci Surgical System for diagnosis and/or treatments associated with the following conditions and procedures:

About Garofalo OB/GYN & Associates

Dr. Garofalo’s practice, Garofalo OB/GYN & Associates, has been designated as a Center of Excellence in Minimally Invasive Gynecology (COEMIG) by the American Association of Gynecologic Laparoscopists (AAGL). According to the Surgical Review Corporation (SRC), which administers the program on behalf of AAGL, more than 650 providers around the world currently participate in the COEMIG program, which was launched in 2010.

For more information on Dr. Garofalo and his medical practice, go to www.garofaloobgyn.com. Dr. Garofalo can be reached for a personal consultation at 203.803.1098.

AAGL Awards Garofalo OB/GYN with COEMIG Designation

AAGL COEMIG Seal_Light2 (2)“I would like to share my news of Garofalo OB/GYN & Associates being designated as an AAGL Center of Excellence in Minimally Invasive Gynecology (COEMIG).”

The COEMIG program is focused on improving the safety and quality of gynecologic patient care and lowering the overall costs associated with successful treatment. The program is designed to expand patient awareness of – and access to – minimally invasive gynecologic procedures performed by surgeons and facilities that have demonstrated excellence in these advanced techniques.

The COEMIG program ensures the safest, highest quality care is delivered to minimally invasive gynecologic surgery patients worldwide, regardless of where they choose to have their procedure performed.

By designating the individual surgeon and facility together, patients are able to distinguish providers who have met the requirements for delivering high-quality perioperative care from those who have not. Insurance companies will also be able to use the designation to identify those committed to excellence.

AAGL only designates this high banner of quality to surgeons and facilities that uphold an unparalleled commitment and ability to consistently deliver safe, effective, evidence- based care. The program is structured to help minimally invasive gynecologic surgery providers continuously improve care quality and patient safety.

For more information about the AAGL, visit www.aagl.org. And for more information on the Surgical Review Corporation, visit www.surgicalreview.org.

Friday, September 13th, 2013 at 10:30

SILS – Single Incision Laparoscopy Surgery on Norwalk Hospital’s Health Talk

health talkcrYesterday, I appeared on “Health Talk” to discuss SILS - Single Incision Laparoscopy Surgery.

In a nutshell, instead of a six-inch incision required by traditional surgery (or even the three to four smaller half-inch incisions utilized in standard laparoscopic surgery), SILS surgery is accomplished through a single small incision in the belly button.

The following operations can be performed by SILS:

  • Removal of uterus (hysterectomy)
  • Removal of ovary (oophorectomy)
  • Removal of gallbladder (cholecystectomy)
  • Removal of appendix (appendicectomy)
  • Repair of paraumbilical or incisional hernia
  • Diagnostic laparoscopy with biopsy

Beginning Sunday, May 19, each evening at 8 and 10 pm, you can view this very infomative segment. Health Talk is Norwalk Hospital’s TV show which broadcasts on Cablevision Local Programming Channel 84.

If you have questions about SILS or need more information, call my office at 203-855-3535.

Monday, May 20th, 2013 at 22:23

Angelina Jolie and the Importance of BRCA1 Testing

angelinacrEarlier this week, Angelina Jolie publicly shared her decision to have a preventive double mastectomy and removal of her ovaries in order to reduce her chances of getting breast cancer and ovarian cancer. According to news reports, Angelina made these decisions after learning that she carried a mutated gene known as BRCA1 which significantly increased her chances of getting breast cancer and ovarian cancer. Angelina’s mother passed away at the age of 56 after a seven-year struggle with cancer. Angelina is in her late 30s.

Here at Garofalo Ob/Gyn, we’ve already had several patients ask about what this means to them, and whether they should undergo genetic screening for the BRCA1 mutation. We’ll do our best to answer some of these questions here.

What are BRCA1 (and BRCA2) genes?

Genes are molecular instructions that hold the information for the human body to build and pass along bodily characteristics such as blood type and eye color. When genes are improperly formed, it’s called a mutation. Mutations can occur during a lifetime or they can be hereditary — inherited from a parent.

Everyone has BRCA1 and BRCA2 genes. (The BR comes comes from “breast” and the CA comes from “cancer.”) In normal cells, these genes play a role in protecting the body against the development of cancer. But individuals with mutations in either of these genes have increased cancer risks, most notably for breast cancer and — for women — ovarian cancer.

What is BRCA testing and what does a positive result mean?

BRCA testing is a genetic blood test that checks the sequence of the BRCA1 and/or BRCA2 genes. It takes about three weeks to get results. A positive result means that the person has a genetic mutation that increases the risk of cancer. Specifically, a positive BRCA1 result for a woman can mean a 60%-80% lifetime risk of breast cancer and a 30%-45% lifetime risk of ovarian cancer. A positive BRCA2 result for a woman can mean a 50%-70% lifetime risk of breast cancer and a 10%-20% lifetime risk of ovarian cancer. For men, the mutation can mean a higher likelihood of prostate cancer, testicular cancer, pancreatic cancer and male breast cancer.

How much does BRCA testing cost?

BRCA testing is usually covered by insurance if certain criteria are met. For example, testing can be less expensive once a mutation has been identified within your family.

What can be done if I have the BRCA1 or BRCA2 mutation?

This is the kind of question that should be discussed with a genetic counselor. The answer may depend on many factors, including your age, health and family history. Since ovarian cancer screening tends to be unreliable, ovarian removal is recommended for BRCA1 and BRCA2 carriers, ideally between the ages of 35 and 40. On the other hand, regular breast screening is good at picking up breast cancers early, and it may be a reliable alternative to mastectomy.

Dr. Garofalo is very experienced in risk-reduction bilateral salpingo-oophorectomy (the surgical removal of both ovaries and the Fallopian tubes) for women who are BRCA1 or BRCA2 positive. This surgery can be done laparoscopically or with the da Vinci Surgical System, as an outpatient procedure with rapid recovery.

 

Do I need to be tested for BRCA1 and BRCA2?

Here at Garofalo Ob/Gyn, we can help determine whether if and when genetic testing is appropriate by exploring your personal and family history. For example, people of Ashkenazi Jewish ancestry are more likely than other groups to have the mutation, as are people with Norwegian, Dutch and Icelandic ancestry.

It’s important to remember that these mutations are relatively uncommon, and that not everyone with one of these mutations develops cancer. However, we encourage all of our patients to be aware of their health conditions and of the risks they may face.

If you have more questions about genetic mutations and cancer risk, just let us know.

About the practice

Laury Berwitt is a nurse practitioner specializing in women’s health in Fairfield County, Connecticut. Laury has a passion for providing quality women’s health care in a safe and comfortable manner by creating a trusting patient-practitioner relationship. She has been in practice for 10 years, caring for women of all ages.

Dr. John Garofalo, M.D., is a gynecologist located in Fairfield County, Connecticut. He has more than 20 years of practice and surgical experience covering many facets of obstetrics and gynecology.

For more information, go to www.garofaloobyn.com. John Garofalo, MD and Laury Berkwitt, APRN can be reached for personal consultations by calling 203.803.1098.

Thursday, May 16th, 2013 at 22:23

Nexplanon: An Effective and Convenient Choice for Birth Control by Laury Berkwitt

One of the most personal decisions our patients make is the type of birth control they use. Our website describes many of the different options available, including barrier methods, hormonal options and intrauterine devices (IUDs), and we regularly help our patients identify the best birth control choice for their unique body, lifestyle and personal preferences.

What is Nexplanon?

One option that’s becoming increasingly popular is a method called Nexplanon. Many of our patients choose Nexplanon because it is discreet, effective, long-acting and convenient. Nexplanon provides long-term, easily reversible contraception that remains effective as it steadily releases hormones over the course of three years.

Nexplanon comes in the form of a small, flexible plastic rod, about the same shape and size as a cardboard matchstick. This rod is placed just under the skin in the upper arm. This insertion is performed during a brief office procedure by a qualified nurse or physician.

Nexplanon’s progestin-only hormones work by preventing an egg from developing. They also thin the lining of the womb, making it hard for a fertilized egg to attach itself. It also thickens the mucus at the entrance of the womb, making entry more difficult for sperm.

Nexplanon was originally marketed under the brand name Implanon, but it was modified slightly — primarily to make insertion of the device easier — and it is now marketed as Nexplanon. Implanon and Nexplanon have been used in more than 30 countries, with more than 2.5 million devices prescribed.

How effective is Nexplanon?

With a success rate of more than 99%, Nexplanon is considered to be the most effective form of contraception currently available, mainly due to the fact that it doesn’t require you to do anything: Studies have shown that user-dependent methods such as birth control pills are 22 times as likely to be associated with unintended pregnancies as Nexplanon. There’s no remembering to take a pill every day or applying a patch or worrying about a vaginal device shifting or falling out of place. You simply have it inserted into your arm — usually a painless procedure — and forget about it for the next three years. After three years, the device can be removed and replaced, all in the same visit. Nexplanon costs between $400 and $800 and is covered by many insurance plans.

What are the side-effects of Nexplanon?

Other than slight, temporary bruising from the procedure, most women experience no negative side-effects from Nexplanon. As with other hormonal contraceptives, many women who have the implant find that their periods become lighter or less frequent. However, in one study about 15 percent of women discontinued use of Nexplanon due to unscheduled or increased bleeding. Other possible side-effects — all relatively uncommon — include headaches, acne, weight gain, breast tenderness, moodiness and abdominal pain. In these cases, or if you wish to become pregnant, Nexplanon can be easily removed. If not replaced by another hormonal contraceptive method, fertility tends to return within a few weeks.

Additional information on Nexplanon

If you think Nexplanon might be a good choice for you, give our office a call. We can provide additional information and help you decide if Nexplanon might be a good choice for your body and your lifestyle. In the meantime, more information on Nexplanon can be found on the Merck & Co. website, at www.nexplanon-usa.com/en/consumer/index.asp.

About the practice

Laury Berwitt is a nurse practitioner specializing in women’s health in Fairfield County, Connecticut. Laury has a passion for providing quality women’s health care in a safe and comfortable manner by creating a trusting patient-practitioner relationship. She has been in practice for 10 years, caring for women of all ages.

Dr. John Garofalo, M.D., is a gynecologist located in Fairfield County, Connecticut. He has more than 20 years of practice and surgical experience covering many facets of obstetrics and gynecology.

For more information, go to www.garofaloobyn.com. John Garofalo, MD and Laury Berkwitt, APRN can be reached for personal consultations by calling 203.803.1098.

Wednesday, May 15th, 2013 at 10:06

Welcome Women’s Health Specialist, Laury Berkwitt, WHNP

It is my pleasure to announce that Laury Berkwitt, a women’s health nurse practitioner, has recently joined my practice.   Laury Berkwitt, WHNP

lauryLaury joins us after working in New York for the last 10 years where she managed the gynecological care for women of all ages.  Laury has extensive experience in providing routine well woman exams as well as managing and treating common gynecological complaints such as abnormal bleeding and vaginitis.   Laury graduated with a Bachelor of Science degree in nursing from The University of Vermont in 1999 and practiced as registered nurse in New York City for three years. She received her Master of Science degree in nursing from Columbia University in 2003. She will spend ample time with her patients helping them to find the best contraceptive method for their unique bodies and needs.  She also has a special interest in the care of adolescent women.  A woman’s first gynecological exam can be a daunting experience, but I am confident that Laury’s calm and nurturing demeanor will help put patients at ease.

Laury is available to see patients and can be reached at 203-855-3535

Many Thanks, John M. Garofalo, M.D.

Wednesday, April 10th, 2013 at 13:17

NOTES: The Newest Frontier In Minimally Invasive Surgery

Insights from Chicago on a potentially safer type of surgery

Last month I went to a conference in Chicago that focused on an exciting new type of surgery — one that has the potential to reduce scarring and recovery times, along with other potential benefits. The conference was the 7th International NOTES® Summit, sponsored by the American Society for Gastrointestinal Endoscopy and the Society of American Gastrointestinal and Endoscopic Surgeons.

What is NOTES?

NOTES stands for natural orifice transluminal endoscopic surgery. The word “translumenal” refers to going beyond the margins of a hollow organ (or “lumen”, such as the stomach or vagina). “Endoscopic” is a type of surgery that uses special surgical instruments to go through small incisions or natural body openings in order to diagnose and treat diseases and other medical conditions. Instead of “traditional” surgery involving large incisions, or even laparoscopy, which uses specialized surgical instruments used through small incisions, NOTES involves interior incisions made within the body’s natural openings. Read more…
Tuesday, October 16th, 2012 at 18:38

SILS Surgery Provides the Potential for No Visible Scars

For many of my patients, the word “surgery” has a host of associated meanings: long hospital stays, time away from home/family/work, significant pain, lengthy recovery period … and visible scarring. I’m excited to say that scarring will become less of an issue for some of my patients in the next few months, when I will start providing a new service called SILS™.

What is SILS?

An acronym for single incision laparoscopic surgery, SILS made its way onto the medical scene in the late 1990s. You may have heard of by a different name: “belly button surgery”. SILS has risen to the forefront of abdominal surgery in recent years along with the development of related technology. While few physicians have received training so far, SILS is gradually catching on.

What are the advantages of SILS?

With SILS, only one umbilical incision is needed to perform the procedure. Using SILS technology, multiple instruments including the telescope can be placed through the incision. (In standard laparoscopy, the umbilical port is used only for observation through the “telescope”. In order to manipulate tissue and place sutures, standard laparoscopic techniques require the placement of two or three additional abdominal ports/incisions.) Compared to traditional port placement, SILS offers a lower risk of complications and additional postoperative pain.

How does SILS work?

Read more…