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Mothers are vital to society because they give life. When asked to summarize motherhood in as few words as possible, the actress Isabella Rossellini said on National Public Radio, "self-sacrifice". Dr. Schmidt agrees. Mothers give life and sacrifice themselves to sustain life. This month, we focus on health matters especially relevant to mothers.
John A. Schmidt, Jr., MD
Internist
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Angelina Jolie had a Double Mastectomy!
This famous mother and actress revealed in an Op-Ed article published in the New York Times that she had a prophylactic  (preventive) double mastectomy and reconstructive surgery earlier this year because she carries the BRCA1 mutation with an estimated 87% chance of developing breast cancer. The same mutation also increases the risk of ovarian cancer. Her mother died of one of these cancers after a ten year battle. Ms. Jolie said that it was painful knowing that her children would grow up without the love and affection of their maternal grandmother.
Experts were quick to point out that the mutation is rare and that prophylactic mastectomy is not recommended for the vast majority of women. Please see the May 21st issue of the New York Times for a description of Ms. Jolie's nipple sparing surgery. Nevertheless, the story serves to remind women of the importance of estimating their risk of developing breast cancer by using a simple calculator, having regular screening mammograms, and consulting their health care providers regarding steps to prevent, detect and treat breast cancer.
Ms. Jolie reportedly delayed the surgery because she wished to breast feed her children. She also plans to have bilateral oophorectomies in the future. The story further points out the need for non-surgical approaches to prevent breast cancer. As reviewed in the April 16th issue of the Annals of Internal Medicine, Tamoxifen reduces the risk of invasive breast cancer and osteoporotic fractures, but increases the incidence of thromboembolic events ("clots"), endometrial cancer, and cataracts, a trade-off most women and physicians are unwilling to accept. There is no effective screening test for ovarian cancer and no drug to prevent ovarian cancer.
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Mothers, Smoking and Breast Cancer
According to the March of Dimes, Mothers who smoke are twice as likely to have a low birth weight infant. They are also at higher risk for breast cancer. In a study published on-line February 28, 2013, in the Journal of the National Cancer Institute, researchers' analyzed data from 73, 388 women in the American Cancer Society's Cancer Prevention Study II (CPS-II) Nutrition Cohort.
During more than 13 years of follow-up, researchers counted 3,721 cases of invasive breast cancer. The rate of new cases was 24% higher in smokers than in non-smokers and 13% higher in former smokers than in nonsmokers. Those who started smoking before their first menstrual cycle had a 61% higher risk, while those who started smoking after their first cycle, but 11 or more years before having a child, had a 45% higher risk. Mia Gaudet, PhD, American Cancer Society Director of Genetic Epidemiology, said breast tissue is not fully developed until after a woman has her first child, and that makes it more sensitive to the harmful effects of tobacco. Dr. Schmidt reminds everyone, especially young women, to avoid smoking and to stop if they already smoke.
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Cautionary Quotation
Joseph A. Caliphano, Jr., Secretary of the Department of Health Education and Welfare (HEW, now known as Health and Human Services, HHS) in the Carter Administration is quoted as saying, "Women who smoke like men die like men who smoke." He predicted that the mortality from lung cancer among women who smoke would soon catch up with that of men who smoke. As reported by Thun, et al. in the Jan 24th issue of the New England Journal of Medicine, his prediction is sadly coming true. There is no universally accepted screening test to detect lung cancer and no medicine to prevent lung cancer. |
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Proton Pump Inhibitors and Hip Fracture
A prospective study published in the British Medical Journal in 2012 showed that risk of hip fracture was almost doubled in post-menopausal women who used Proton Pump Inhibitors (Prilosec, Nexium, etc.). Risk increased with duration of therapy and was higher in smokers. If you are a long term user of a Proton Pump Inhibitor, ask Dr. Schmidt if a "drug holiday" is appropriate for you. |
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Osteoporosis and Motherhood
Osteoporosis is prevalent in post-menopausal women and almost half of Caucasian women will suffer an osteoporotic fracture after the age of 65. Bone mineral density, one of the key determinants of fracture risk, decreases during pregnancy and breast feeding as calcium is transferred from mother to child. 
However, as reported in a Danish study published in Osteoporosis International in April, 2012, the losses are completely reversible. By 19 months postpartum, bone mineral density in the spine and hips returned to the woman's pre-pregnancy baseline. Dr. Schmidt's patients who use the World Health Organization (WHO)-endorsed FRAX calculator to estimate their fracture risk will notice that there are no points deducted for pregnancy or breastfeeding.
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Expansion of Medicaid and Women's Health
As reported in the May 2 issue of the New England Journal of Medicine, a pilot expansion of Medicaid in Oregon in 2008 led to a 30% increase in the number of women receiving PAP screening and twice as many women 50 years of age or older receiving screening mammograms. New Jersey is one of 26 states that have so far agreed to expand its Medicaid program under the auspices of the Affordable Care Act (ACA, "ObamaCare"). With up to 14 million additional American citizens eligible for Medicaid coverage, more than half of them non-elderly women, this is a major step forward for women's health. |
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Busting His Buttons!
On Monday, May 20th, Dr. Schmidt's daughter, Rita, graduated from Robert Wood Johnson Medical School following in the footsteps of her mother, Dr. Rita Watson, and her two older sisters, Kathryn and Susan. Rita was hooded by Drs. Schmidt and Watson, both of whom are members of the school's teaching faculty. "Rita Jr." will train in Internal Medicine at the New England Medical Center/Tufts University School of Medicine in Boston where her brother John attends the Berklee School of Music.
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Now Hear This!
Dr. Schmidt will be away on vacation from May 25 until June 2. His colleague, Dr. Maseda, will handle emergencies and cover hospitalized patients. Unless absolutely necessary, please delay requests for refills, etc. until Dr. Schmidt returns on June 2. Email should be directed to Valerie at valrich@schmidtmd.com during this period. Valerie will respond to voice messages left at 732-282-8166 as usual. Thank you!
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Aging from a Mother's Point of View
One of Dr. Schmidt's favorite musicals, Pippin, is back on Broadway! The lyrics from one of the show's many hit songs, " No Time at All," are amusing and wise:
"When you are as old as I, my dear, and I hope that you never are, you will woefully wonder why, my dear, through your cataracts and catarrh, you could squander away or sequester a drop of a precious year, for when your best days are yester, the rest'er twice as dear!"
The song is sung by the character, Berthe, Pippin's Grandmother. Thank goodness for mothers (and grandmothers) who have graced us with their love!
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