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Breast cancer is the leading cause of cancer deaths in women in the U.S. That’s why early detection is so important. Dr. George Krakora, a radiologist with Renown Institute for Cancer, explains what to watch for and how new technology can lead to early detection. Most women know the importance of breast health and staying current with annual breast exams, but may not know that both screening guidelines and technology is evolving. So we asked George Krakora, MD, a radiologist for the Renown Institute for Cancer, what every woman should know about breast cancer detection and which screening method is right for them. First off, when should women start getting breast exams? Generally, women should start getting breast exams using mammography or ultrasound after they turn 40 years old. But we also want women ages 18 to 39 to talk to their primary care provider and ask for what’s called a formal risk assessment to see if screening is needed sooner. And you want to make sure your care provider is giving you a breast exam starting at age 25. It’s also a good idea to be familiar with how your breasts look and feel so you can report any changes to your care provider. What are the risk factors for breast cancer? Are there any preventive steps women can take? There a few risk factors you can’t control, like your age, family history of breast or other cancers, and if you have dense breast tissue. Your risk for breast cancer increases as you get older, and most breast cancers are diagnosed after age 50. Knowing your family history is important because a history of cancer and shared lifestyle can raise your risk. Your breast density can also increase your risk: Women with high breast density are four-to-five times more likely to get breast cancer than women with low breast density. But the good news is there are quite a few things you can do to prevent breast cancer, like not smoking, watching your alcohol intake, and maintaining a healthy weight with good diet and exercise. There are a lot of newer screenings out today. What is the difference between 2-D and 3-D mammography? In a 2-D mammogram, the tech takes X-rays of the breast. These pictures can show the radiologist if there are any lumps or tumors you might not be able to feel. In 3-D mammography, the process is largely the same but more X-rays are taken and it takes a few seconds longer for each image. This kind of exam detects 41 percent more cancers and reduces the number of false-positive results given to patients. This improvement in technology is great for both patients and their care providers. 3-D mammography provides better images of the breast, which allow doctors to more clearly diagnose and avoid false positives, especially in women with dense breast tissue. And what about a whole breast ultrasound. What is that? A whole breast ultrasound uses sound waves to detect cancerous tumors in the breast without using any radiation — it’s an ultrasound just like pregnant women get to check up on their baby. And the exam only takes about 20 minutes. We recommend these exams for patients whose mammograms have shown that they have dense breast tissue. Dense breast tissue can make it harder for doctors to see any abnormalities, lumps or tumors in a mammogram, so this technology ensures better early detection.

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Watch as two dads look back on their newborn adoption process. They reminisce about discovering their newborn was on his way — and how Renown Health subsequently helped them navigate the process.  During Memorial Day weekend, Chris Mulhern and his husband, Jeffrey Bodimer, learned a set of birth parents chose them to parent their unborn baby boy. After writing a letter to the birth parents, they were chosen over other applicants in a private adoption. The adoption agency took care of many details, like connecting Mulhern and Bodimer to the birth mother and dad. In fact, they could participate in nearly all the phases of the pregnancy. The mother's prenatal care and delivery took place at Renown Health, where Mulhern and Bodimer attended her appointments and took childbirth classes. "Our experience was wonderful at Renown," says Mulhern. "We thought it was absolutely incredible how nice and accepting everyone was." The Nuances of Newborn Adoption Their son, Bradley, was born via cesarean section. And the adoptive parents got to see him an hour after he came into the world. The labor and delivery nurses even helped coordinate everything between them and the birth mom. Mulhern and Bodimer stayed in a room at The Inn at Renown. The closeness of the facility on the Renown campus made it possible to feed Bradley every two hours. Incredible Nurses "They were great, the nursing staff. If we weren't sure about doing something right, about burping him right they would say 'It's okay. He's not going to blow up. He will eventually do it'," says Mulhern. The nurses also made arrangements for the two dads to participate in skin-to-skin contact with their newborn baby. Experts agree parents and babies should be in direct contact for at least the first 1–2 hours after the birth. Taking Baby Home Chris and Jeffery took Bradley home after three days at Renown. “It was the most joyful thing to be chosen as his parents, even before we met him,” says Chris.

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SOGI stands for sexual orientation and gender identity. Being a SOGI-inclusive medical facility means regardless of our differences, we treat others with dignity and respect. Sean Savoy, Renown Health Manager of Spiritual Care, explains SOGI terms and their importance in a healthcare setting below. SOGI History Although the UN passed a historic resolution on SOGI in 2016, it is still a relatively new term for some. Above all, an inclusive environment where every patient feels safe and valued, improves the quality of care in our community. In reality, defining gender and sexuality can be confusing. However, the terms we use to define gender and sexuality are an important influence on how we relate to each other. Generally, "sex" refers to the biological differences between males and females. Still the term “sex” doesn’t fully capture the complex biological, anatomical and chromosomal variations that can occur. Accordingly, having only two (binary) options – biological male or biological female – might not describe what’s going on inside a person’s body. In essence, assigned sex (also called "biological sex) is given at birth based on medical factors. These include your hormones, chromosomes and genitals. Most people are assigned male or female, and this is what’s put on their birth certificate. When someone’s sexual and reproductive anatomy isn’t clearly female or male, that person may be described as “intersex.”  However, a person’s biological or assigned sex may be different from a person’s actual or perceived gender identity or expression. The word “gender,” therefore, is more difficult to define. It could refer to the gender or sex role society determines is acceptable, desirable or appropriate based on a person’s perceived sex. Likewise, it could refer to an individual’s own gender identity or preferred gender expression. What is Gender Identity? To summarize, gender identity is one's innermost concept of self as male, female, a blend of both or neither. To clarify - how individuals perceive themselves and what they call themselves. Of course sometimes a person's genetically assigned sex does not line up with their gender identity. These individuals might refer to themselves as transgender, non-binary, or gender-nonconforming, for example. Another key point is the process of gender transition. This specifically refers to more closely aligning your internal knowledge of gender with your outward appearance. According to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM), the term – which replaces Gender Identity Disorder – "is intended to better capture the experiences of affected children, adolescents, and adults." What is Sexual Orientation? Sexual orientation is an internal or enduring emotional, romantic or sexual attraction to other people. For example, you could be heterosexual (straight), gay, lesbian, bisexual or even pansexual. SOGI Terms to Know Below are some common SOGI terms according to the National LGBT Health Education Center and the Human Rights Campaign. The following list is not meant to represent every term (or definition) used by the LGBTQ+ community. LGBTQ+ Stands for lesbian, gay, bisexual, transgender and queer (or questioning). The plus encompasses other identities that fall under the queer umbrella with one common theme: they are not strictly straight or cisgender. Queer An umbrella term used by some to describe people who think of their sexual orientation or gender identity as outside of societal norms. Some people view the term “queer” as more fluid and inclusive than traditional SOGI identities. Due to its history as a derogatory term, the term is not always embraced or used by all members of the LGBTQ+ community. Sexual Orientation Terms Asexual (adj.) – Describes a person who experiences little or no sexual attraction to others. Asexuality is not the same as celibacy. Bisexual (adj.) – A sexual orientation that describes a person who is emotionally and sexually attracted to people of their own gender and people of other genders. Gay (adj.) – A sexual orientation that describes a person who is emotionally and sexually attracted to people of their own gender. It can be used regardless of gender identity, but is more commonly used to describe men attracted to other men. Heterosexual or Straight (adj.) – A sexual orientation that describes a person whose sexual or emotional attractions and behaviors focus exclusively or mainly on members of the opposite sex or gender identity. Lesbian (adj., noun) – A sexual orientation that describes a woman who is emotionally and sexually attracted to other women. Pansexual or Omnisexual (adj.) – A sexual orientation that describes a person who is sexually and emotionally attracted to people of any sex or gender identity. Pansexual people may refer to themselves as gender-blind, asserting that gender and sex are insignificant or irrelevant in determining whether they will be sexually attracted to others. Gender Identity Terms Bigender or Binary (adj.) – Describes a person whose gender identity is a combination of two genders. Cisgender (adj.) – A person whose gender identity aligns with the assigned sex at birth or biological sex. Gender non-conforming (adj.) – Describes a gender expression that differs from a given society’s norms for males and females. Gender transition (noun) - The process by which some people strive to more closely align their internal knowledge of gender with its outward appearance. Some people socially transition, whereby they might begin dressing, using names and pronouns and/or be socially recognized as another gender. Others undergo physical transitions in which they modify their bodies through medical interventions. Intersex (adj.) - A variation in sex characteristics including chromosomes, gonads, or genitals that do not allow an individual to be distinctly identified as male or female. Non-binary Alternate terms are gender queer and gender non-conforming. Transgender (adj.) – Describes a person whose gender identity and assigned sex at birth do not correspond. Also used as an umbrella term to include gender identities outside of male and female. Sometimes abbreviated as trans. SOGI Awareness Again, not all people use the above terms in the same way, so respect and sensitivity are key. And the healthcare setting is an especially vulnerable one. Maintaining the dignity and humanity of every individual during a medical interaction is essential. The U.S. Department of Health and Human Services requires all Electronic Health Record (EHR) systems be able to collect SOGI information from patients. This promotes better understanding of health treatment outcome disparities in order to reduce them. Renown Health’s mission is to make a genuine difference in the health and well-being of the people and communities we serve.

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According to the American Cancer Society, approximately 14,100 new cases of invasive cervical cancer will be diagnosed, and 4,280 women will die from cervical cancer. However, cervical cancer is preventable with regular screening tests and the HPV vaccine. It’s important to note that medical advances have allowed progress in diagnosing and treating cervical cancer. While it used to be one of the most common causes of cancer death for American women, the incidence of death has significantly declined. What to Know About the HPV Vaccine HPV vaccination is the best way to prevent cervical cancer and is recommended for all youth starting as early as age 9, or for teens and adults up to age 45 who didn’t start or finish the series. In Nevada, only 50.1% of teens ages 13-17 have been vaccinated for HPV.  There are 13 types of HPV, and the vaccine Gardasil 9 protects against 9 of those HPV strains, greatly reducing the incidence of cervical cancer among vaccinated individuals. What to Know About Cervical Cancer Screenings The CDC says the most important thing you can do to help prevent cervical cancer is to have regular screening tests starting at age 21. And there are two common tests that can detect early stages of cervical cancer (or precancer) and improve health outcomes. The pap test (or pap smear). This screening looks for precancers. Women should begin getting pap smears when they’re 21. The human papillomavirus (HPV) test looks for the virus that can cause these cell changes. Cervical Cancer Screening Schedule The American Cancer Society offers the following guidelines for screenings: All women should begin cervical cancer screening at 21. Women between 21 and 29 should have a pap test every three years. Beginning at 30, the preferred way to screen is with a pap test combined with an HPV test every five years. This is called co-testing and should continue until age 65. A pap test (or pap smear) is performed during a regular screening appointment to look for precancers, cell changes on the cervix that might become cervical cancer if they are not evaluated or appropriately treated. Typically outpatient procedures can reduce the risk of long-term health impacts that prevent pre-cancerous cells from becoming cancer cells. Women over 65 who have had regular screenings in the previous ten years should stop cervical cancer screening as long as they haven’t had any severe precancers found in the last 20 years. How to Get Screened Request an appointment with your primary care physician or OBGYN to schedule a screening.

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March is Colorectal Cancer Awareness Month, and we want you to receive the best preventative care possible. Early detection can help prevent serious illness, yet many people still choose to skip their annual exams and routine screenings. Bonnie Ferrara, MD, MPH, Section Chief for Primary Care at Renown Medical Group, further explains the importance of this simple, easy way to stay healthy. Why are annual exams so important? The benefits of early detection and prevention to save lives and reduce the impacts of disease have been proven. These exams are the perfect opportunity to get your health questions answered. “This is your chance to sit down with your provider and talk about your overall health and your family’s health history as well as your concerns for the future,” says Bonnie Ferrara, M.D., family medicine. “It’s the opportunity for your provider to talk with you about your lifestyle, tobacco use, exercise and alcohol use, all of which make a difference in your future longevity.” The annual wellness exam is also an ideal time for most adult patients to discuss health screenings. In addition, these visits are the perfect time to address issues that may not directly relate to a particular medical problem or immediate illness. A good rule of thumb is to schedule these appointments around your birthday each year to make sure you and your provider are both updated on your care. Why would you need an annual exam if you aren’t feeling sick? According to Dr. Ferrara, seeing your care provider when you aren’t sick is one of the best times. “It is better if you try to arrange this visit when you are not feeling ill,” she says. “It is an opportunity to talk about wellness. Not only how to contribute to your wellness but also the changes that you can make that will make huge dividends in the future for your wellness. In addition, it allows us to do some education about what to expect in the coming years as far as your health and lifestyle changes.” What can you expect at an annual exam? Annual exams usually check your: History – lifestyle behaviors, health concerns, vaccination status, family medical history Vitals – blood pressure, heart rate, respiration rate and temperature General appearance – your care provider can find out a lot about you just by watching and talking to you Dr. Ferrara adds, “If this is a Medicare annual wellness exam, it is an opportunity to talk to your provider about depression and dementia as well as be tested for those.” You can also leverage your annual exam to speak to your provider about managing your chronic health problems. "As a provider, these visits give us the opportunity to hear how the medications and lifestyle changes we have recommended are working and if you are having problems with these, we have the opportunity to make suggestions of how to do things better for the future," Dr. Ferrara.

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In this article reprinted with permission from the Galena Times,  Dr. Max J Coppes, Physician-in-Chief, Renown Children’s Hospital, and Nell J. Redfield, Chair of Pediatrics, UNR Med, talk about adolescents vaping, and how an estimated additional 10 million teens are at risk to start using e-cigarettes. What are E-cigarettes? E-cigarettes are battery-operated devices heating a liquid (e-juice) into an aerosol to be inhaled. Breathing in this flavor vapor, which usually contains nicotine, anti-freeze or other cancer-causing chemicals is called ‘vaping.’  There are many forms of these electronic nicotine delivery devices - and they're not always obvious. They not only appear to be cigarettes, cigars, or pipes, but also pass for everyday items, such as flashlights, flash drives or pens.   The Effects of Vaping and E-cigarettes Regardless of the nicotine delivery, vaping is addictive and is quickly becoming a public health concern. Nicotine levels in e-cigarettes vary greatly, and they may also contain toxic chemicals. Currently there is a wide range of variability among vaping products. In other words - they deliver different ingredients, hardware, levels of nicotine, and possible toxic chemicals to the user. This makes it challenging to create an overall public health recommendation on their use. Nevertheless, there is no confusion about the harmful effects of the chemicals used in e-cigarettes to the young brain, which develops until age 25. Studies show e-cigarette use serves as an introductory product for teens to go on using ‘regular’ tobacco products. The American Academy of Pediatrics has several recommendations on their use. Such as increasing the minimum age to buy tobacco products, including e-cigarettes, to age 21 nationwide. (Update: nationwide the age as of January 2, 2020 is now 21.) A common misunderstanding with teenagers is the belief e-cigarettes are less harmful than other tobacco products. Moreover, there is a wide range of flavor choices, from mint, mango, crème brûlée to cucumber to attract users. As of September 6, 2019, The Centers for Disease Control and Prevention is reporting over 450 possible cases of lung illness associated with the use of e-cigarette products in 33 states.    What Should Parents Know about Vaping? Parents and teachers should know JUUL is a very popular e-cigarette among teenagers, capturing about 68% of the market. JUUL is sleek, small, hides easily, and resembles a flash drive. Surprisingly it charges in an USB port, and can also instantly be mistaken for a real flash drive. One JUUL cartridge contains twice the nicotine found in other e-cigarette cartridges. This roughly equals the amount of nicotine in an entire pack of cigarettes. To repeat, the use of JUUL in young people continues to grow, and this is why parents and teachers need to be aware. Be alert, teach, communicate, and talk to your child about the serious risks of smoking in all forms, whether at home or parties. Tell them how difficult it is to quit and why they should not start. Loving your children is caring; caring for their current and future health and well-being.

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