Breast Cancer: Perspective on the Experience

In continuing observance of Breast Cancer Awareness Month, we are once again sharing Total Health Radio podcasts on related topics.  These are the final two episodes in a series of three all about breast health — from genetics to life as a cancer survivor.

Check out this second episode in the series, “Breast Cancer: After Diagnosis.”


 

And this third episode called, “After Cancer: A New Normal.”

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Research Improves Detecting Ovarian Cancer While Sparing Women Unnecessary Surgery

Elizabeth Suh-Burgmann, MD

Elizabeth Suh-Burgmann, MD

Elizabeth (Betty) Suh-Burgmann, MD, chair of gynecological oncology for Kaiser Permanente’s Northern California Region, has been doing research to improve clinical care of gynecologic cancer throughout her career.

With ultrasounds being performed on patients more often, occasionally abnormalities are discovered that doctors weren’t initially looking for. Dr. Suh-Burgmann was interested in small, complex, ovarian masses discovered in women over age 50, who are at greater risk of ovarian cancer than younger women. While difficult to treat successfully in its later stages, ovarian cancer has a good prognosis if found early. However, the only way to know immediately if these small masses are cancerous is to remove them surgically, leading some women to have surgery for non-cancerous masses.

Dr. Suh-Burgmann reviewed the charts of approximately 1,800 KP NCAL members and identified 1,400 who had these masses. Her research showed that the rate of malignancy was quite low among the group of small, complex, ovarian masses she studied. The findings were published online Sept. 8 in the American Journal of Obstetrics and Gynecology.  We sat down with her recently to talk about her work and the findings of this study.

Q:  Your research resulted in new clinical practice guidelines. Tell us about them.

A:  In April we implemented new radiology templates and practice recommendations in Northern California that are designed to reduce the number of unnecessary surgeries while identifying cancers more readily. Providers and radiologists like using them because they have a clear, recommended, evidence-based path for what to do based on the ultrasound and clinical characteristics of masses. Our shared goal is to spare women unnecessary surgery while providing assurance that worrisome masses receive prompt evaluation.

Q:  Why is ovarian cancer so difficult to detect?

A:  Unfortunately, it’s not always possible to distinguish between cancerous and noncancerous masses accurately on an ultrasound. Furthermore, levels of the CA125 protein, which is specific to ovarian cancer, are elevated in only half of women who have early-stage disease. In the majority of women with ovarian cancer, the disease has begun to spread before they have any symptoms.

Q:  What kind of masses did you study and why?

A:  When a woman has an ovarian mass, there’s always a concern that it’s cancer. Large masses are always removed and tested, but there has been no clear guidance for what to do about smaller masses, which could be cancer or, much more likely, benign tumors or cysts. I looked at masses under 6 centimeters that radiologists described as “complex,” which means that they have ultrasound characteristics that raise some concern for cancer.

Q:  How did you do this study?

A:  With the help of Yun-Yi Hung, PhD, at the Division of Research, I looked in KP HealthConnect for women age 50 and over who had these small, complex masses, no symptoms of disease, and no elevated CA125 levels, to see what happened to them. I was here many evenings, reviewing charts. I got really efficient at it.

This is the first large, population-based study that actually looks at the risk of ovarian cancer in this group. The actual rate of malignancy was quite low. Only seven out of 1,362 of these masses were actually cancer—just one in 200. That’s a lot lower rate than most women’s-health providers have been taught to assume. Also, no masses that remained stable for more than 7 months later turned out to be a cancer or borderline tumor.

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Breast Health and Genetics: What You Should Know

In recognition of Breast Cancer Awareness Month, we will be highlighting a series of three episodes of Total Health Radio over the next few weeks that focus on breast health — before, during and after a cancer diagnosis.

In this episode, we explore breast cancer screenings and the role of early detection in survivability. Our host speaks with OB/GYN Cristina Amaya about breast cancer screenings, and genetic counselor Monica Alvarado talks about the role our family history plays in a breast cancer diagnosis.

Total Health Questionnaire: Loel Solomon

Loel Solomon is vice president of community health for Community Benefit at Kaiser Permanente. He lives in the Bay Area with his wife and two great kids. 

Loel Solomon, Vice President of Community Health for Kaiser Permanente

Loel Solomon, Vice President of Community Health for Kaiser Permanente

Q: In a few words, what does Total Health mean to you?
A: I am connected to loved ones, doing meaningful work in the world, getting sleep and taking care of myself…and that I am living in a neighborhood and workplace that supports my healthy choices.

Q: Which person, living or dead, is your health hero or role model?
A: 
Jack Geiger – he saw that healthcare is necessary but insufficient to secure the blessing of health.

Q: What is your favorite food?
A: 
Dim sum – truth be told.

Q: What do you value most in your work? What inspires you to continue?
A: It’s the people I have the good fortune to work with, both at Kaiser Permanente and our partners.   I keep on learning about all the different pieces that contribute to health – how it’s all connected – and how we all have such a vital piece of the health puzzle.

Q: In your opinion, what is the most underrated way to improve health for individuals?
A: Creating “optimal defaults” to shift behavior – by using principles of behavioral economics and behavioral design.  Some people are also calling this “choice architecture.”  It’s powerful stuff!

Q: Where would you most like to live?
A: 
Exactly where I live – in the East Bay of Northern California.  Natural beauty, diversity, great food, walkable cities – and a place that is generating so much  great thinking and doing around healthy communities.

Q: What do you consider your greatest achievement so far?
A: First, being raised by two great kids.  They (and their peers) are the hope of the world.  And a ton of fun.  Second, co-founding the Convergence Partnership, a group of national funders and the CDC which have really helped bring equity and multi-sectoralism into the conversation about what really drives health, and how to invest in it.    

Q: If you could have dinner with any three people, living or dead, who would you pick?
A: Yikes.  A great grandmother I never net.  She was a card, apparently.  Nelson Mandela, FDR, the Dalai Lama, Studs Terkel, Robert Reich, Khaled Hosseini.

Leadership Perspectives: Good Health Starts Where You Are

Editor’s Note: Today, we launch a recurring feature on the Center for Total Health Blog. “Leadership Perspectives” is a collection of guest blog posts from Kaiser Permanente leaders all about why we need to take a Total Health approach.

Today’s guest author is Elisa Mendel, national vice president of HealthWorks & Product Innovation for Kaiser Permanente, who shares her thoughts on place-based health.


 

How much time would you guess you spend at work each year? Would you be surprised if I said it’s something like 2,000 hours?

Elisa Mendel, VP of HealthWorks & Product Innovation for Kaiser Permanente

Elisa Mendel, VP of HealthWorks & Product Innovation for Kaiser Permanente

Compare that to the time we spend with our doctor — maybe 15 minutes once or twice a year? That’s why place-based health is so important. At its core, good health starts with us — where we live, work, learn, and play.

That’s one of the reasons Kaiser Permanente partnered with leading national organizations to launch Thriving Schools. The idea is that schools are the hub of every community. Our work in schools focuses on four key areas: healthy eating, active living, school employee wellness, and a positive school environment. One of the active living programs is called Fire Up Your Feet. Fire Up Your Feet’s fall campaign launches October 1, and it encourages kids to walk to school with their parents, giving them much-needed exercise and some quality time together.

Another initiative I really love combines the childhood enthusiasm for play with the workplace. It’s called “Instant Recess.” A manager or wellness champion schedules time with their team —usually about 10 minutes. Everyone stops what they’re doing, and one of the team members leads the group in dancing and exercise. People are moving, getting their blood pumping, and laughing together. It’s had amazing results, because when you’re doing the chicken dance with your supervisor, suddenly things feel a little less stressful.

Kaiser Permanente piloted this in various work settings — call centers, IT, and even the ICU. One of the ICU patients heard the staff doing this Instant Recess every day on the floor and she was determined to get out of bed so she could be wheeled out to participate in the fun.

There’s no limit to the benefits of healthy living. It can lift spirits and deliver real business results. One study in the Journal of Occupational and Environmental Medicine showed that employees who ate healthy and exercised regularly were up to 27 percent less likely to be absent from work for health reasons.

Good health is becoming a national movement. Find your “healthy,” and start to share good health close to your home.

Domestic Violence: It’s a Health Issue

October is Domestic Violence Awareness Month — a good time to pause and consider just how many people are affected by domestic violence and sexual assault. The numbers are astounding. According to the National Coalition Against Domestic Violence, an estimated 1.3 million women are victims of physical assault by a domestic partner each year. And one in every four women will experience domestic violence in her lifetime.

Adults aren’t the only ones affected. Every year, nearly 1.5 million high school students experience physical abuse from a dating partner. One in three adolescents is a victim of physical, sexual or emotional abuse.

This episode of Total Health Radio talks about what teen dating violence looks like and some of the warning signs parents and friends should be watchful for. Guest Nancy Schwartzman, the inventor of the Circle of 6 mobile app, shares ways that young women can both prevent and cope with sexual assault.

Falling for Autumnal Eats

Pumpkinmuffin_cbIf you are like most people, you love fall — one survey claims that it’s the season Americans like best.

Many appreciate this time of year because of the autumnal climate.  My own theory?  It’s the food.

Fall is the time of year when we feel emboldened to use spices that may come on too strong during spring and summer.  The aromatic earthiness of nutmeg.  The zingy bite of cinnamon.  The cozy warmth of cloves. Resonant spices that just make us feel good.

The Food for Health bloggers know this well.  That’s why they’ve welcomed the fall season with a recipe for Pumpkin Muffins. Kate Land, MD, the recipe’s author, says these are, “healthy, hearty and perfect for breakfast.”

Check out the recipe over at the Food for Health blog.  And follow Dr. Land on Twitter: @KPkiddoc.

 

Categories: Food
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School is in Full Swing: How Are Your Kids Doing?

The school year is underway, and by now students are settling into their classes — as well as their cliques. In a time when bullying has become pervasive, whether on the playground or online, it’s worth asking the question: How can we best equip our children with the skills and behaviors they need to resolve conflicts on their own?

This episode of Total Health Radio features a conversation with Anabel Castrezana, a marriage and family therapist from Kaiser Permanente Southern California, who shares ways we can model empathy and healthy expressions of emotion for our kids — including our toddlers. Check it out, and let us know what you think.

Total Health Questionnaire: Joy Lewis, MSW, MPH

Joy Lewis is a senior health policy leader in Kaiser Permanente’s Institute for Health Policy. She has a background in social work and arrived in Washington, DC, from Los Angeles about 3 years ago with her son.  

Joy Lewis, MSW, MPHQ: In a few words, what does Total Health mean to you?
A: It means the full compliment of the spiritual, physical, intellectual, cognitive, emotional all coming together to propel and motivate me through each day/each week/each month/each year.

Q: Which person, living or dead, is your health hero or role model?
A: My role model is my maternal grandmother, Zippporah, who lived to the ripe old age of 96. She exemplified “good living”. She took care of herself and her family’s needs on a daily basis. She was careful to maintain her spiritual perspective which I believe allowed her to be very humble and loving and giving to those whose paths she crossed. She lived a very simple life – one void of many earthly possessions but her spirit was beyond rich (as were the lessons she imparted).

Q: What is your favorite food?
A:
Any non-meat with amazing spices.

Q: What do you value most in your work? What inspires you to continue?
A:
The ability to think creatively and deeply about topics that are of utmost importance to transforming the health care sector. The U.S. health care system is in fact going through a period of significant change, and change that I believe is directionally correct. My inspiration comes from the many lives who require us to “get it right.”

Q: If you could change one thing in health care, what would it be?
A: The disparities that exist in our health care system  – disparities that are based on one’s zip code, race/ethnic group, and other socio-economic circumstances.

Q: In your opinion, what is the most underrated way to improve health for individuals
A: Investing in prevention-related activities. The question that is often asked is whether or not investing in prevention pays off in the long-run (lower costs to the system, and better health outcomes). I think most of us would prefer to find ourselves in a situation where an illness is prevented before it occurs vs having to go through treatment. So while the “definitive” answer to the prevention question evades us, I would advocate for a greater emphasis on preventive care and implementation of those strategies that will promote lasting and optimal healthy defaults (for example: encouraging physical activity).

Q: Where do/would you most like to travel?
A:
I absolutely love to travel. So send me most places and I’m good. I hope to make my next trip to Australia or somewhere in Asia.

Q: What do you consider your greatest achievement so far?
A:
Being a mom. The job is never-ending, but I love it. I consider myself fortunate and privileged to be given the chance to impact another human being’s development in such a profound way. I take my role as a mom very seriously and I am intentional and deliberate in my parenting style.

Q: If you could have dinner with any three people, living or dead, who would you pick?A: Nelson Mandela, Oprah Winfrey, and George Clooney.

Exercise is the New Vital Sign!

Since the dawn of the doctor’s visit, taking vital signs has been a mainstay. Height, weight, temperature, heart rate, blood pressure. It’s a routine process that we participate in almost without thinking.

But at Kaiser Permanente, after the blood pressure cuff comes off, you’ll get questions that might surprise you: how many days a week do you exercise moderately or strenuously? How many minutes a day do you exercise at this level?

Come again? At first thought, asking about physical activity levels might seem unorthodox. Unlike other vital signs, it’s measuring a behavior, not a body part. But conventional thinking about health and health care has changed, and systems like Kaiser Permanente recognize that addressing personal behavior and lifestyle is just as important as addressing biology.

A new KP Policy Story from Benjamin Wheatley of the Kaiser Permanente Institute for Health Policy highlights our “Exercise as a Vital Sign” (EVS) initiative. Since 2009, Kaiser Permanente providers have asked patients about their exercise habits during routine office visits. Taking this “vital sign” encourages ongoing conversations between patients and providers about physical activity, and serves as a gateway for referring patients to activities such as yoga, Zumba classes or hiking clubs. Recent research shows positive results of the EVS initiative: in 2013, we found that asking about exercise habits is associated with modest weight loss in overweight patients and improved glucose control among diabetics.

You can read the story in its entirety at the Institute for Health Policy site.

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