Newsletter - Andrea Stein, M.D.
SUMMER 2011
PAP Smears, Mammograms, Vitamin D, Calcium, Colonoscopy Revisited
Disclaimer: the information contained herein is intended for general information. It does not substitute for the opinion and care from one's licensed health care provider.PAP SMEARS
Guidelines keep changing and often for good reasons. For example, we test all sexually active young women for STDs but do not start PAP smear screening for cervical cancer until 21. The treatment for an abnormal PAP in someone under 21 often does more harm than good. Healthy young women "cure" the problem causing an abnormal PAP (usually HPV) with their own immune system. "Older" women in stable relationships who have had several normal PAP smears no longer need a PAP with their annual examination. A change in partners, bleeding or other "exceptions" apply. And so guidelines have changed for many medical screening tests and continue to evolve. Often they must be individualized.
MAMMOGRAMSI think most of us need a baseline by 40, then every 1 or 2 years depending on a number of individual risk factors. Some need to start earlier or perhaps add an ultrasound or MRI.
VITAMIN D
Vitamin D doesn't cure illness, but it and calcium are needed in moderation for bone health. Too much may cause kidney stones. Look at the FDA guidelines (www.fda.gov) to see your optimal intake (no special formulations are necessary.
COLONOSCOPY
These procedures can detect or prevent colon cancer, but there may be complications. Recommendations are for most of us to start by 50, then repeat every 5-10 years. Colon cancer is one of the most common cancers in women (lung, breast, colon). Virtual colonoscopy requires radiation and is an alternative for select individuals.
Book Review by Dr. A. Stein
Published (and adapted) from Fertility and Sterility March 1, 2011; 95:1195.The Immortal Life of Henrietta Lacks by Rebecca Skloot
New York, NY: Crown Publishing, 2010 (This has been on every best-seller list all year and is required reading for many of the colleges and universities.)
Rebecca Skloot addresses bioethics, genetics, race and medicine in The Immortal Life of Henrietta Lacks. It is a story worth reading, learning, remembering and, ultimately, teaching.I always thought her name was Helen Lane. I was wrong. It was a newspaper misprint. Her name was really Henrietta Lacks, a beautiful woman with a husband, 5 children and a large extended family. She died at Johns Hopkins Hospital in the "colored" ward at 31 years of age. No one told her, or her family, they had taken some of her cervical cancer cells for research. Henrietta Lacks' doctors included some of the "greats" in obstetrics, gynecology and genetics. This was the era before modern research ethics, bioethics or informed consent. Yet it was after the Nuremburg Code and Belmont Report. These became the first cells that could be grown in perpetuity in cell culture.
Anyone who has worked with tissue culture has heard or worked with HeLa cells. They came from Henrietta Lacks without her (or her family's) knowledge. With this book, HeLa cells come alive as a person. Just as clinicians are taught to treat each patient as an individual, Rebecca Skloot teaches us that every cell has a story.
In the 1970s, 25 years after Mrs. Skloot's death, her family first learned of the legacy of HeLa cells. Ms. Skloot uses her decade of investigation, interviews, and journalistic skills brilliantly (www.RebeccaSkloot.com) . The Immortal Life of Henrietta Lacks reads like a novel. The book addresses issues of domestic violence, institutional horrors (particularly human experimentation), scientific discovery (e.g. cell culture, basic genetic techniques, vaccine development), infectious disease (HPV infection) and bioethics.
In summary, The Immortal Life of Henrietta Lacks is part biography, part history, and a great deal of ethics. It should be required reading for every physician, scientist, patent attorney, ethicist, and book club.
And finally, a little bit about my professional and personal interests...
Andrea L. Stein, M.D. grew up in the North Suburbs of Chicago. Her undergraduate training was at the University of Illinois and her medical school was at the Rosalind Franklin University-Chicago Medical School where she met her husband. She then moved to Los Angeles to train in Gynecology-Obstetrics at Los Angeles County-University of Southern California, followed by a fellowship in Reproductive Endocrinology. She has practiced in Los Angeles since 1988. Her current practice is office-based gynecology, focusing primarily on reproductive medicine, menopause, hormone management, infertility, and adolescent gynecology.Dr, Stein's other professional interest is reproductive ethics. She completed a fellowship in Bioethics in 2001. She is an active member of numerous ethics committees, including UCLA Hospital and the American Society of Reproductive Medicine. (ASRM).
Dr. Stein is a Clinical Professor at USC where she continue volunteer teaching. She is or has been on the Board of Directors of several medical societies and is a certified practitioner of the North American Menopause Society (www.menopause.org). She love to garden, travel, and "repurpose: antiques or other items.