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  • January 18, 2022

    By MedStar Team

    Structural racism is one of the most pressing issues facing healthcare today.  Unfortunately, academic medicine historically exacerbating the exploitation of vulnerable communities to achieve educational and research goals, especially in Black, Indigenous, and People of Color (BIPOC) communities. For example, many traditional research practices among marginalized communities highlight and, in most cases, magnify inequities in care. These can include:   

    • Community members are under informed about research methods and strategies. 

    • Researchers prioritize extraction of information from communities rather than community ownership of information.

    • Researchers accrue funding, prestige, and publications (in which academics’ voices predominate over the narrative perspective of community members) without similar accrual to participating communities.  

    • Researchers’ understanding of questions to be answered may lack cultural context because of their incomplete comprehension of community conditions.  

    The relationship between research institutions and many BIPOC communities is estranged and needs mending to dismantle racial disparities and inequitable research practices. As the area’s largest healthcare provider, MedStar Health is committed to do the work needed to address these issues in everything we do in order to advance health equity for everyone we serve.

    “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” – Dr. Martin Luther King, Jr.

    (March 25, 1966 speech to the Medical Committee for Human Rights)

     

    Advancing Health Equity in Early Childhood and Family Mental Health Research

    MedStar Health investigators Arrealia Gavins, Celene E. Domitrovich, Christina Morris, Jessica X. Ouyang, and Matthew G. Biel recently published research emphasizing the need to co-learn and to co-develop research with community members themselves to prioritize benefits for both participants and researchers. “Advancing Antiracism in Community-Based Research Practices in Early Childhood and Family Mental Health” was published in the Journal of the American Academy of Child & Adolescent Psychiatry. This work was done through the Early Childhood Innovation Network (ECIN),  a community-based partnership between two academic medical centers (MedStar Georgetown University Hospital & Children’s National Health System) and several community-based organizations in Washington, DC that strives to provide support to families through caregiver and child mental health services, family peer support, child social and emotional learning, initiatives to address social determinants of physical and mental health for families, and place-based support to families within select communities.  

    In this study, researchers found that to begin to undo the inherent inequities within academic medical research, particularly in studies involving children and caregivers, investigators need to consider how best to build equitable, long-term partnerships with communities through Community-Engaged Research (CEnR) or more specifically, Community-Based Participatory Research (CBPR). CBPR offers an alternative to traditional non-participatory research with a collaborative, strengths-based orientation that equitably involves researchers, community members and other stakeholders in all phases of research while embracing their unique expertise. 

    Recently documented increasing rates of depression, anxiety, and suicide in BIPOC youth, compounded by the disproportionate impact of the COVID-19 pandemic on BIPOC communities, has heightened the urgency for progress in community-based research.

    The research team started to utilize CBPR practices to advance antiracism in their clinical research work in child and family health along with working with BIPOC communities. This approach to integrate CBPR practices into the development, implementation, and evaluation of community-based interventions seeks to support early childhood mental health in primarily Black communities in Washington, DC. 

    Making an Impact: Insights & Lessons Learned from CBPR

    Through this work of the EICN, the research team found five valuable lessons from applying CBRP principles to research collaborations in community settings. 

    Intervention Practices

    Lessons Learned and Applied

    ECIN launched a group-based mindfulness parenting program to explore how to support the emotional health of parents at a Head Start early education center with the intention to reduce caregiver stress and enhance caregiver-child relationships.

     

    Lesson 1: Invest the time to build trusting relationships

    Providers set up several discussion groups with community partners and medical center-based researchers to review proposed assessment tools to be used with children and families receiving psychotherapy services.

    Lesson 2: Involve community partners in the development of the intervention theory of change and measurement strategy

     

    Clinical staff organized peer specialists to provide support to families with young children through 3 evidence-based strategies: enhancing parents’ knowledge about caregiving with young children;optimizingparent use of existing resources; and increasing parents’ access to social supports.

     

    Lesson 3: Create interventions in partnership with community members

    Clinical staff providedearly childhood mental health consultation (ECMHC) in preschool classrooms to enhance educators’capacitiesto support early childhood development and to recognize early signs of mental health concerns

    Lesson 4: Interpret findings in partnership with community members

    ECIN membersparticipatedin formal antiracism training with external experts to incorporate antiracism principles into ECIN’s operations and into the culture of the Network. ECIN formed a Racial Equity Community of Practice (RECOP), that supports 8 intervention teams in developing practices that advance racial equity goals.

    Lesson 5: Embed an antiracism focus in research structures and processes

     

    The research team found this community-based approach to be helpful in conducting research that will have a long-lasting impact on not only the community, but also on members of the research team. During a time where BIPOC families are experiencing the effect of COVID-related deaths and grief, unemployment, housing instability, and police violence; researchers have an opportunity to be engaged in the community and work to eliminate racial inequities within academic medicine and research. 

    Journal of the American Academy of Child & Adolescent Psychiatry, DOI: 10.1016/j.jaac.2021.06.018

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  • October 22, 2020

    By Marc E. Boisvert, MD, Breast Surgery

    Estimated reading time: 4 minutes

    Over the past decade, advances in breast cancer have been changing women’s lives for the better.

    Take breast conservation surgery. Lumpectomy followed by radiation therapy removes only diseased tissue, leaving healthy tissue intact. Yet it delivers a high success rate previously achieved only via mastectomy, total removal of the breast.

    Radiation delivered to the site of a tumor has long been acknowledged as one of the most critical defenses against a return of the cancer. And, for many women, Intraoperative Radiation Therapy (IORT)—administered immediately after lumpectomy—is now the fastest, most convenient way to dispense that radiation.

    IORT is delivered in a single treatment, in the operating room, right after surgery. While conventional whole-breast radiation requires treatment five days each week for up to seven weeks, IORT takes an average of just 30 minutes, saving the patient multiple post-surgery hospital visits.

    Proven in trials worldwide, IORT recently achieved a landmark 18 years of research data—the gold standard for demonstrating a cancer treatment’s safety and effectiveness.

    Radiation Post-Lumpectomy

    Surgery alone does not deliver the best possible odds of preventing cancer’s return. But a focused dose of X-ray energy can destroy the DNA of cancer cells and stop their replication.

    Following lumpectomy, IORT lets us direct the radiation precisely where it needs to be—into the tumor bed, the empty space left behind after the tumor is removed. This is the space in which tumors would be most likely to recur. The treatment is so accurately focused on the tumor site, it gets the job done in just one treatment, at a fraction of the dose typically applied in whole-breast radiation.

    Following lumpectomy, a single 30-minute dose of intraoperative radiation therapy—IORT—can accomplish what can normally take weeks of daily visits. Learn more from Dr. Marc Boisvert. @MedStarWHC via https://bit.ly/3jbaJ7f
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    Since 2012, MedStar Washington Hospital Center and MedStar Georgetown University Hospital have been the only medical centers in the Washington, D.C. area equipped to offer this valuable therapeutic approach to breast cancer patients. Between the two hospitals, we have completed close to 200 procedures, most of them now included in the U.S. research trial registry. While our full analysis of the procedure’s performance will take some time, we know anecdotally that it has been very effective and has saved hundreds of hours of post-surgical maintenance for women and their families.

    For women undergoing lumpectomy, the simplicity, speed and convenience of IORT is a real game-changer.

    Simple, Fast, Convenient

    An ideal candidate for IORT is typically a woman 50 and over, whose tumor is three centimeters in size (just over an inch) or smaller, non-lobular and both estrogen- and progesterone-positive.

    Although whole-breast radiation after surgery can save lives—and is still a recommended approach for some women—it requires a higher dosage and carries a greater risk of side effects, including increased wound contracture, swelling and skin irritation. And treatment cannot be started until three to four weeks after surgery, when the surgery site is relatively healed.

    IORT, on the other hand, is performed minutes after surgery, eliminating repeat visits after recovery. Research shows it to be as effective in the appropriate patient population as whole-breast radiation, at less cost. And as mentioned, it can spare the patient the inconvenience of follow-up visits to the hospital several days a week for radiation care.

    Lumpectomy with IORT

    In the operating room, our lumpectomy patient is put to sleep, and the breast surgery team removes the tumor. Then, the radiation oncology team takes over. They position the IORT machine and calculate the dosage of radiation based on evidence-based guidelines. It is delivered via a smooth, round applicator, placed directly into the tumor bed via the surgeon’s incision.

    We protect the skin where radiation can cause irritation and redness, taking careful measurements to ensure the applicator is not too close. Once activated, the machine is left in place for 20–35 minutes, as the patient sleeps. The radiation field is very shallow, so the heart and lungs are never at risk.

    Following radiation, we remove the applicator and close the incision in the normal fashion, and the patient is taken to the recovery area. IORT adds no extra recovery time, and unpleasant side effects are rare.

    Path to a Cure

    Typically, patients consult me after their screening mammogram shows an abnormality. The patient then meets with the breast surgeon, and together we begin our approach to treatment. We take an extensive medical history and evaluate risk factors, family history, mammography and follow-up imaging, and biopsy findings.

    If cancer is confirmed, the patient’s information is presented to our multi-disciplinary tumor board, a team of experts working together to determine a unique course of action for each patient.

    The board includes eminently qualified surgery, medical oncology, radiation oncology, plastic surgery, rehabilitation, pathology, nutrition and genetic counseling staff, as well as breast surgery and oncology fellows. Many of our board members have been colleagues for decades.

    We assign a nurse navigator to communicate the treatment plan to the patient and coordinate consultations and procedures. Depending on the tumor board’s recommendation, the navigator helps the patient get scheduled with the relevant specialists on our team.

    By the time surgery is scheduled, the patient has seen everyone she needs to see, and our entire team knows the plan for that patient. We work together to make surgery and continuity of care as efficient and effective as possible, a truly comprehensive, multi-disciplinary effort.

    Here at MedStar Washington Hospital Center, our leading-edge medical research gives breast cancer patients access to newly developed treatments.

    Don’t Delay Care

    Like any cancer diagnosis, time is of the essence when it comes to breast cancer. The later the cancer, the more challenging the diagnosis and treatment, with more procedures and potential side effects. So of course, it’s always preferable to treat early whenever possible.

    That’s why your screening mammogram is so important!

    And don’t let the pandemic keep you from getting the care you need. We continue to adhere to strict safety and screening protocols regarding COVID-19 to protect patients and staff. Your safety is our top priority.

    Good breast health is critical.

    Talk to our care team today.

    Call 202-877-DOCS (3627) or Request an Appointment

  • October 21, 2020

    By Clara Yoder, BSN, RN, CCRN

    Some people may delay a lung cancer screening or other routine screenings out of fear of diagnosis. But the truth is, getting screened early can significantly improve your chances of survival if something abnormal is found. This is especially true in the case of lung cancer, as early detection can save your life.

    You can’t afford to wait for lung cancer symptoms to appear.

    A lung cancer screening is an imaging test used to search for and identify any signs of cancer in your lungs before symptoms appear. If you delay testing until you experience signs of lung cancer, such as persistent coughing, shortness of breath, or coughing up blood, you risk allowing cancer to progress to a later stage. Often, if symptoms are present, the cancer is already beginning to spread. And, once lung cancer begins to grow in size or spread, it becomes much harder to treat.

    Early detection increases your survival rate.

    If you catch early signs of lung cancer before symptoms appear, you have more treatment options and chances for a cure. In fact, people who are diagnosed with early-stage lung cancer experience a 27 to 61 percent five-year survival rate, depending on the type of lung cancer. In contrast, once lung cancer has spread to both lungs or surrounding organs in later stages, the five-year survival rate is only 3 to 6 percent, according to the American Cancer Society.

    Are you eligible for a lung scan?

    Ask lung health questions live on WMAR TV.

    How can lung cancer be detected early?

    Medical advances in x-ray technology make it easier to find cancer in its earliest stages when it’s most curable. Today, doctors use a low-dose computed tomography scan, or low-dose CT scan, to get a detailed look at your lungs and nearby organs. The x-rays create a 2D image of your lungs, allowing your doctor to find and track tiny spots called nodules, which can grow into cancer.

    During a low-dose CT scan, you’ll lay down on a table that passes through a CT machine, similar to a large metal donut. The entire screening takes between 15 to 30 minutes, and it’s completely painless. Your doctors can follow any abnormalities found to ensure it doesn’t develop into cancer over time. If your doctor notices a change in size, they may recommend further evaluation to ensure it’s not cancerous.

    Learn more about what to expect during a lung cancer screening.

    Is LDCT radiation exposure harmful?

    Low-dose CT scans use significantly less radiation than traditional CT scans. In fact, the amount of radiation exposure in a low-dose CT scan is less than half of the standard radiation that you’ll unknowingly receive within one year in the United States just going about daily life. The benefits of early detection far outweigh any potential risks associated with the minimal amount of radiation exposure.

    If you’re at risk of #LungCancer, your best chance for a cure is early detection through screenings. Lung nurse navigator Clara Yoder shares why on the #LiveWellHealthy blog: https://bit.ly/3o8na7L.

    Click to Tweet

    Smoking is the most common cause of lung cancer.

    Smoking is the number one cause of lung cancer, which is why you can greatly reduce your risk of lung cancer if you stop smoking. Even if you’ve tried to quit before, it’s never too late to try again. Talk to your doctor about which smoking cessation resources may help you kick the habit for good and minimize your risk of lung cancer. From prescriptions covered by insurance to virtual counseling classes, we can help you take the next step in protecting your health.

    While 85 to 90 percent of all lung cancer cases are attributed to smoking, environmental factors can also increase your risk of developing lung cancer. Exposure to high radon levels in old homes or asbestos levels in certain work environments, for example, can pose a threat to your lung health.

    Unlike other types of cancer, lung cancer is not genetic. That means that even if a family member has lung cancer, you’re not genetically prone to developing the disease. However, if a family member smokes in close proximity to you on a regular basis, your risk of developing lung cancer increases because you are exposed to secondhand smoke.

    When is the best time to get screened for lung cancer?

    If you are a current smoker or have a history of smoking, the best time to get screened for lung cancer is before you have symptoms. The Centers for Medicare and Medicaid Services (CMS) guidelines recommend lung cancer screening for individuals who:

    • Are between the ages of 55 and 75 years old
    • Have no signs or symptoms
    • Have a 30 pack-year smoking history (e.g you have a history of smoking a pack of cigarettes a day for 30 years, or 2 packs of cigarettes a day for 15 years)
    • Currently smoke or quit within the past 15 years

    Even if nothing is found during your low-dose CT scan, it’s important to continue getting screened annually. If something suspicious is found, your care team may repeat the screening in three to six months to see if a nodule is growing and act accordingly.

    In order to get the clearest results during your low-dose CT scan, it’s important to be clear of any respiratory infections, such as pneumonia or COVID-19. Respiratory infections can result in shortness of breath or a persistent cough, which are also signs of lung cancer. Seek medical care if you are having trouble breathing or a cough that won’t go away so your doctor can treat any infections before you get screened for lung cancer.

    The sooner lung cancer is detected, the better.

    If you meet eligibility for lung cancer screening, don’t delay. A low-dose CT scan may save your life by detecting early signs of cancer. When found early, lung cancer treatment is easier and more effective, giving you the best chance for survival and more time with those you love.

    Want to learn more about lung cancer prevention, detection, and treatment?
    Click below for more information.

    Lung Cancer Screenings and Diagnosis

    Lung Cancer House Calls Live Events

  • October 20, 2020

    By Judith H. Veis, MD, Nephrology

    True or false: Chronic kidney disease, or CKD, causes more deaths than breast cancer or prostate cancer.

    The answer: True! A largely under-recognized public health issue, CKD is the ninth leading cause of death in the U.S. today.

    And hardest-hit by chronic kidney issues? The African American community. Although African Americans constitute 13% of the population, they suffer more than triple the rate of kidney failure of Caucasians. Over ⅓ of patients receiving kidney dialysis in this country are African American. And this demographic is 3½ times more likely to experience end-stage renal disease, compared to non-Hispanic whites.

    The numbers are certainly alarming. But, before we explore some potential reasons for them, let’s take a quick look at how kidneys function—and malfunction.

    Your Personal Waste Disposal Unit

    Kidneys are the body’s personal recycling bin. They remove waste, regulate fluid balance and ensure electrolyte and mineral balance. The kidneys also control your blood pressure and regulate how many new red blood cells your body makes.

    With every beat of your heart, over 20% of the blood that’s pumped goes directly to your kidneys, where millions of tiny filtering units—or glomeruli—filter blood, extracting plasma. Then the rest of the kidney processes what has been filtered to return what is needed to your body while excreting what you don’t need.

    Symptoms and Risk Factors

    Like high blood pressure, CKD can be a silent threat. When the kidneys are damaged or fail to function properly, a patient may initially experience no symptoms, until damage gradually becomes more severe.

    Some possible risk factors for kidney disease may include:

    • High blood pressure (hypertension)
    • Diabetes
    • Pre-diabetes
    • Heart disease or heart failure
    • A family history of CKD, kidney failure, or dialysis
    • Overweight or obesity

    For most patients with high blood pressure or diabetes, concurrent kidney disease happens very gradually, over time.  An occasional exception might be malignant hypertension, when an unusually radical spike in blood pressure could lead to kidney failure, as well as stroke or heart attack.

    The Five Stages of CKD

    For most people, kidney failure occurs after years of having CKD. Kidney damage progresses through five stages.

    In the earliest stages, the kidneys begin to leak proteins such as albumin into the urine. This is called proteinuria, an excess of protein in the urine. Uncontrolled over time, this excess can lead to kidney failure, when the kidneys no longer function well enough to eliminate fluid and electrolytes, keep the body clean, and prevent illness caused by high levels of waste products. At this stage, dialysis or a kidney transplant is likely required to maintain health.

    The Glomerular Filtration Rate (GFR) checks how much blood passes through the glomeruli—those tiny filtering units—per minute. As the filtration rate declines, the kidneys become more and more compromised. The five stages, as defined by the National Kidney Foundation, look like this:

    • Stage 1—Normal or high GFR (GFR >90 mL/min)
    • Stage 2—Mild CKD (GFR = 60–89 mL/min)
    • Stage 3A—Moderate CKD (GFR = 45–59 mL/min)
    • Stage 3B—Moderate CKD (GFR = 30–44 mL/min)
    • Stage 4—Severe CKD (GFR = 15–29 mL/min)
    • Stage 5—End Stage Renal Disease/Stage 5 CKD (GFR <15 mL/min)

    Of course, as nephrologists, our mission is to strive to keep patients from reaching stage 5.  Perhaps we’re able to make an early diagnosis by discovering a little protein in their urine. Or we watch carefully to assure that their blood pressure doesn’t get too high or that their diabetes is not out of control. As we try to manage these symptoms through stages 2, 3, and 4, we use medicines to reduce stress on the kidneys so they don’t struggle to work so hard. With this approach, we’re typically successful in slowing the rate at which kidneys fail.

    Kidney disease can sneak up when you least expect it. Don’t forget to get your annual checkup done. https://bit.ly/3jYwzMK @MedStarWHC @veisneph
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    Considerations for African Americans

    We look at several factors that seem to spur higher levels of kidney disease within our African American population:

    • Biological Factors
      • Prevalence of diabetes: The higher incidence of diabetes in our African American community translates to a higher risk for the kidneys. Diabetes occurs when sugar levels become too high in the blood. Glucose can infiltrate cells without insulin receptors—in the back of the eye, in the retina, within the peripheral nervous system, and in some of the filtering units of the kidney—and cause damage. The damage stimulates more scar tissue, which causes reduced kidney function and potentially more protein leakage. This, in turn, leads to even greater scarring and damage to the kidneys, in a hazardous cycle.
      • Prevalence of high blood pressure: Genetic factors certainly play a role in the higher incidence of high blood pressure in African Americans. And a high-salt diet can make it worse. High blood pressure can also contribute to hypertensive nephrosclerosis—scarring the glomeruli and diminishing their functionality.
    • Genetic Factors
      Approximately 15% of the African American population has two copies of an abnormal gene called APOL1. Risk of CKD increases markedly for people who have two copies of APOL1 in combination with another risk factor, such as diabetes or hypertension.
    • Other Factors
      Taking non-steroidal anti-inflammatory drugs (NSAIDs), such as Aleve® (naproxen), Motrin® (ibuprofen), and Advil® (ibuprofen), can potentially inflict damage to the kidneys. In high doses, these medications may interfere with a patient’s blood pressure medicines and cause a rise in blood pressure. Tylenol®—which is acetaminophen, not an NSAID—can be safely taken by people with kidney disease.
      Kidney function can also be negatively impacted by infections, severe dehydration, or acute damage due to heart disease.

    Testing for CKD

    Two simple tests provide a primary care doctor with the basic information they need to diagnose a patient’s kidney health.

    • The Estimated Glomerular Filtration Rate (eGFR) test measures the patient’s blood creatinine level. Based on age and other factors combined with the patient’s creatinine level, the test delivers an estimated filtration rate. If your eGFR is less than 60%—less than 60 mLs per minute—you would likely be referred to a kidney specialist.
    • An ACR urine test will measure your albumin-to-creatinine ratio and indicate any noteworthy increase in the level of urine albumin (microalbuminuria). Kidneys which are a little leakier of protein than normal are considered under stress, and an ACR in the high range will likely prompt a referral to a kidney specialist.

    Prevention and Treatment

    Kidney disease is rarely painful and can easily hide until it’s progressed to a more serious stage.

    As a first line of defense, maintaining a healthy weight, following a low-salt diet, and getting regular exercise can go a long way to keep kidneys healthy. Individuals with kidney disease in their family should see their primary care doctor for blood pressure, pre-diabetes and diabetes screenings, and ACR testing to ensure urine free from microalbuminuria.

    Here at MedStar Washington Hospital Center, our specialists check for complications from high blood pressure and long-term diabetes. For example, we may request results of a recent eye exam or call for a new one, or we may discuss with patients possible nerve damage from their diabetes.

    Then, treatment typically starts with medications to help the kidneys leak less albumin and reduce the overall stress on the kidney. We make sure the patient’s diabetes is controlled and blood pressure is low, and we counsel on diet.

    For example, in a hypothetical scenario where a patient has a slightly elevated ACR, but kidney function is normal and blood pressure is a little high, we might treat the blood pressure and work with the patient to lower it, in turn reducing the ACR.

    Occasionally, we might explore for a possible structural issue, such as a kidney stone or enlarged prostate that’s blocking flow from the kidneys.

    Some Tips for Everyone

    My general advice to stay kidney-healthy is to listen to your body and drink water when it tells you to replenish fluids. The amount of water to drink daily is different for everyone, so let your own thirst be a guide. If you have kidney stones, keep drinking more than two quarts of liquid every single day.

    Also, try to reduce sodium. Consume less animal protein, particularly red meat. Schedule a checkup immediately if your urine contains blood, or if the urine becomes very foamy, indicating the presence of excess protein. If your family has a history of kidney ailments, you’ll want to discuss that with your primary care provider.

    And don’t let COVID-19 stop you from visiting one of our specialists. Our staff at the Hospital Center is making very effective use of the telehealth option. Of course, for people with advanced kidney disease, there’s no substitute for listening to the heart and lungs, and we schedule those patients for a physical examination.

    Time for kidney testing?

    Review your options with our specialists.

    Call 202-644-9526 or  Request an Appointment

  • October 15, 2020

    By Christopher M. Gallagher, MD

    After skin cancer, breast cancer is the most common cancer in women; only lung cancer is deadlier. This serious disease will affect over 275,000 American women this year alone. Of those, 42,000 will not survive—and that’s why it’s so important for women over 40 to have regular mammograms.

    But there’s good news, too. The outlook for recovery from breast cancer is far brighter than it was in decades past. Each year, science and medicine make new discoveries and refine treatments.

    Breast cancer spans a spectrum of diseases that target breast tissue and it’s important that we understand their biology and behavior.

    This form of cancer can be the result of many factors. Genetic factors trigger about 5%–10% of all instances, but most cases affect women with no genetic predisposition. Also among the risk factors are use of alcohol, obesity and increased breast density.

    But for most women diagnosed, their breast cancer is not the direct result of a lifestyle choice. Unlike most cancers, even tobacco use isn’t directly implicated, although smoking is still a very bad idea as it complicates treatment and recovery.

    In breast cancer, the better the diagnostic information, the better the outcome. And our information gets more accurate each year. More from Dr. Christopher Gallagher. https://bit.ly/34VjAVQ via @MedStarWHC
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    The Genetic Connection

    Certain women are genetically predisposed to breast cancer, and genetic counseling is an important part of the MedStar Health breast cancer program. Red-flag risk factors include: any breast cancer diagnosis under age 50, a diagnosis of triple-negative breast cancer for a patient under age 60, a strong family history (a mother or sister with breast cancer), and cancer found in both breasts.

    The most commonly implicated genes are mutations in two specific genes, abbreviated as BRCA1 and BRCA2. A mutation can increase a woman’s lifetime risk of breast cancer up to 50% over women without the mutation.

    The BRCA mutation also increases the risk of ovarian and other types of cancer. It is often the culprit in cases of male breast cancer and, depending on the mutation, could also increase the risk of prostate cancer.

    Genetic screening gives us the information we need to make decisions about treatment—for example, preventative surgery (especially after childbearing years) or an increase in breast screening, sometimes with MRI to complement mammogram and ultrasound. And screening can protect the entire family, since sisters, daughters and mothers may also be at risk.

    Breast Cancer Types

    Our first line of defense is understanding the nature of the cancer and matching it to the best evidence-based treatment. The more we know, the better the outcome.

    Just 25 years ago, treatment was limited, and breast cancer was much less survivable. Today, with new medicines targeting specific cancer cells, the majority of women are diagnosed with early stage breast cancer.

    • Estrogen and Progesterone Receptor Status (ER+/PR+): In ER positive (ER+), the most common type of breast cancer, the tumor’s growth is fueled by estrogen. It is less aggressive than other types. We tend to treat it long-term, and anti-estrogen medications can help prevent recurrence. Since ER+ often responds well to estrogen suppression, many women with this cancer may not need chemotherapy.
      .
      Similarly, some tumors grow in the presence of progesterone (PR+), and these likewise respond to hormone therapy.
      .
      An ER negative (ER-) tumor does not depend on estrogen and, because it doesn’t respond to anti-estrogen therapy, it calls for more aggressive treatment.
    • HER2 Status: HER2 is a normal protein that helps regulate how breast cells grow, divide and repair. But too much HER2 may promote breast cancer growth.
      .
      HER2-positive tumors can be aggressive, but we have a variety of advanced therapies to target the HER2 protein. It is an area of very active research, and two new medications were approved by the FDA this year and have become available for use. The prognosis for HER2-positive tumors is good, especially when caught early—another compelling reason to stick to your mammogram schedule.
    • Triple Negative: When a tumor grows without any help from estrogen, progesterone or HER2, it’s the most aggressive form of breast cancer, known as triple negative. This diagnosis typically requires a full range of treatment—including chemotherapy—to afford the best odds of more cancer-free years.

    In Situ or Invasive

    Within the breast tissue is a network of lobes, lobules and ducts that produce and transport milk after childbirth. Breast cancer most typically occurs in either the milk duct or in a lobule, one of the glands that produce milk.

    When the cancer is isolated to a duct or lobule, it’s considered in situ, meaning “in its original place.” In situ cancers are not life-threatening, but their presence can increase the risk of developing a more invasive form of breast cancer over time.

    Invasive, or infiltrating, ductal carcinoma begins in the milk duct. It’s described as invasive because it has infiltrated surrounding breast tissue. More rarely, tumors can appear in the lobule, and this is known as lobular breast cancer.

    Proteins Are Key

    For all types of breast cancer, we’re interested in the proteins which the cancer cells produce. The protein expression helps us classify the cancer and deliver a treatment protocol that will produce optimum results.

    In years past, breast cancer was breast cancer—we didn’t have the tools to differentiate one type from another. Today, we target and isolate tumor cells much more accurately. We make decisions about medication, surgery, radiation and chemotherapy based not just on the size and location of the tumor, but on its specific biology.

    Genomic testing is on the leading edge of breast cancer diagnoses. It enables us to analyze the tumor’s entire genome, the entirety of its genetic code, not just one or two isolated genes within it. Years ago, tumor size was the prime indicator. With advanced genomics, we are given an increasingly clearer view into the internal mechanism of the cancer cells. That is a much more reliable pathway to a cure.

    The Path to Treatment

    Most women are directed to see an oncologist after a screening mammogram uncovers a suspicious mass, or when a lump or bump is found during self-examination. Of course, it’s not always cancer. A variety of benign breast diseases, including unusual calcification or evidence of fibrocystic disease, can also spur a doctor visit.

    It’s typical for the patient to then return for additional imaging studies. If the mass remains suspicious, we’ll do a needle biopsy, the most reliable way to get a sample of the abnormal cells for lab studies. The biopsy is done on an outpatient basis. The test is quick, using local anesthesia to numb the area and limit discomfort. It requires no stitches, and most women return to normal activity after a day or two.

    Biopsy results provide the information we need to tailor treatment to the type and stage of disease. At MedStar Washington Hospital Center, treatment planning is very much a team effort. Each case is reviewed by a panel of experts, including breast surgery, medical and radiology oncology, plastic surgery, genetic counseling and physical therapy. The team works collaboratively towards a cure, leveraging every possible resource.

    Because every woman and every cancer is unique, each plan is custom-tailored for the best possible results.

    Staging has also advanced significantly. Years ago, the stage of the cancer was determined by where the cancer was found—whether it was confined to the breast tissue or spread to the lymph nodes, most often under the arm.

    Today, staging is much more nuanced. Tumor size and lymph node involvement are important, but hormone receptor and HER2 status and even genomic test results are used so that we can be more confident in determining if the cancer was responsive.

    Three decades ago, almost all women with breast cancer required a mastectomy (removal of the breast). In the 1980s and 90s, we learned that removing only the mass—lumpectomy—followed by radiation can be just as effective, with less than 2% odds of the cancer returning. Without radiation, those odds jump to 20–30%.

    At the Hospital Center, we want our patients to have the best possible outcomes. Information guides our decisions—and the information gets better and more accurate with each passing year. Today, many breast cancer patients have the potential to be cured the minute they leave the operating room.

    Through clinical trials conducted at our Cancer Institute, breast cancer patients also have access to leading-edge research with opportunities to receive next-generation treatment.

    The Importance of Mammograms

    The most survivable breast cancer involves small tumors in their earliest stages. The mammogram remains our most powerful tool for detecting these tumors. Thirty years ago, before screening mammography became the standard of care, less than 2% of precancerous growths were found. Today that number is at 20%, a significant lifesaving advance.

    Even the smallest lump or bump should be investigated. If a patient waits too long to act on this, it doesn’t take long for a cancerous growth to move past the most treatable phase. Given the chance, more aggressive varieties can migrate to other parts of the body—significantly reducing the odds of successful treatment.

    For survivors as well, we encourage them to continue with their annual mammograms, to monitor the potential return of the previous cancer or spot any new growths.

    Most women can be cured of early-stage cancer—and sometimes we can only discover those cancers with screening mammography.

    Breast Cancer and COVID-19

    There is no reason to delay your annual mammography screening during the coronavirus pandemic. The Hospital Center is taking all necessary precautions, including pre-test COVID-19 screening, personal protective equipment and temperature checks. We have also expanded our telehealth visits and imaging hours to accommodate patients’ needs.

    Cancer doesn’t stop with the pandemic, and fortunately women have continued coming to us for diagnosis and treatment. That means that lives are being saved.

    Due for your mammogram?

    We are safe and ready to care for you.

    Call 202-644-9526 or Request an Appointment

  • October 14, 2020

    By Dr. Howard Bassel, Urgent Care and Family Medicine Physician, MedStar Health

    While COVID-19 and the flu have similar symptoms, there is one distinct difference—we have an effective vaccine to lower your risk of getting the flu. Now, more than ever, it’s critical to get a flu shot to keep yourself and others as healthy as possible.

    Similarly to COVID-19, the flu can be deadly for certain groups of people.

    It’s true that more people have died this year from COVID-19 than the flu. But that doesn’t mean the flu shouldn’t be taken seriously. Last year nearly 20 thousand people in the United States died as a result of complications from the flu. And during the previous year, roughly 50 thousand people died from the flu. One death is too many, especially when there are steps we can take to protect ourselves and our loved ones.

    In a similar fashion, COVID-19 and the flu are both airborne infections that are easily spread through droplets expelled from the mouth and nose. Both can result in a fever, body aches, and coughing—or worse. Like COVID-19, aging adults or kids under the age of two with preexisting health conditions, such as asthma, high blood pressure, or heart conditions, can experience secondary infections from the flu, like pneumonia, that may result in hospitalization or even death.

    There’s no vaccine yet for COVID-19, but you can protect yourself and those around you from the flu.

    Although research and development of COVID-19 vaccine is underway, we’re still a long way off from having a readily available vaccine to prevent the disease. However, we do have a way to control one virus during the upcoming months, and that’s with a flu shot.

    The flu shot can reduce your chances of getting the flu.

    The flu shot has been proven time and again to minimize your risk of getting the flu. Scientists and doctors are vigilant about studying current strands of the flu in order to predict which strands are most likely to circulate between September through April. So, while the flu shot doesn’t offer 100 percent immunity against current strands of the flu, typical protection offers 50 to 70 percent. This means far fewer people will get infected with the flu. And, even if you do come down with the flu after getting vaccinated, you’ll experience fewer and milder symptoms than if you didn’t get the flu shot.

    Vaccination can decrease the burden on our healthcare providers who are caring for patients with COVID-19.

    This is the first time it’s possible to become infected with the flu and COVID-19. Because of this, there’s a lot we don’t know about how our bodies will react. Certainly getting infected with both can be a deadly combination, especially for individuals who have a greater risk of complications.

    By getting a flu shot, you reduce your chances of getting seriously ill from the flu and being hospitalized. With fewer people hospitalized because of the flu, healthcare providers will have more time and energy to focus on caring for those who are seriously ill with COVID-19 or other diseases.

    Getting a flu shot is a courteous way to minimize your risk of spreading the flu to those around you.

    If there’s any silver lining to what we’ve experienced with COVID-19, it’s a greater awareness of the importance of taking safety precautions to protect ourselves and others. Just like social distancing and wearing a face mask, getting a flu shot during the pandemic not only keeps you healthier, it can reduce your chances of spreading the flu to someone else. In fact, if enough people get vaccinated for the flu, we can achieve herd immunity. That means the majority of our population could become immune to the flu and therefore, can’t spread it to others.

    Getting a #FluShot during the pandemic is one step you can take to protect yourself and those around you. On the #LiveWellHealthy blog, Dr. Bassel and Dr. Kennedy share why you especially need to get vaccinated this year: https://bit.ly/3jZ2MU3.

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    How to safely get a flu shot during the pandemic.

    Who should get a flu shot?

    We recommend that everyone above the age of six months gets vaccinated for the flu. Similarly to COVID-19, getting a flu shot is especially important for aging adults and people with other health issues. Individuals with comorbidities, like asthma, diabetes, or heart disease, are at an increased risk for developing complications from the flu. This is why it’s critical to get a flu shot during the pandemic. And, unlike COVID-19, children under the age of two are also at a greater risk of developing being hospitalized from the flu, especially if they have underlying conditions, including heart issues or seizures.

    Even if you aren’t considered to be in the high-risk group, getting a flu shot ensures you’re doing your part. You’ll minimize your chances of getting the flu and spreading it to someone who may have a weakened immune system.

    When should I get a flu shot?

    Flu season begins in September and lasts throughout spring, and the flu shot is already readily available. It takes your body nearly two weeks to respond to the flu shot and develop antibodies that will protect you. So the earlier you can get a flu shot during the pandemic, the better. Getting vaccinated early means you’ll have immunity sooner than if you delay getting the flu shot.

    If you have an infection of any kind, whether you’ve tested positive for COVID-19 or you’re already experiencing flu-like symptoms, wait to get your flu shot until you’ve recovered. Once you’ve been without a fever for over 24 hours without needing to take medication to lower your temperature, then you should get a flu shot.

    Where should I get a flu shot?

    Getting a flu shot now is easier than ever, as the vaccine is more widely available than its been previously. Many pharmacies, fire departments, state-run flu clinics are providing flu shots, but the first place you should ask about a flu shot is your primary care doctor. In many cases, your doctor can provide the vaccine or direct you to another safe location that can, like a MedStar Health urgent care.

    At MedStar Health, we continue to take your safety and health seriously. We’re staggering appointments for flu shots, limiting points of entry to encourage social distancing, and maintaining separate spaces for treating those who are sick and those who are healthy.

    The flu can travel just as fast as COVID-19. Let’s all do our part to minimize its threat by getting a flu shot during the pandemic.

    Need a flu shot?
    To find a MedStar Health primary care provider or nearby urgent care center, click below.

    Primary Care and Urgent Care

  • October 13, 2020

    By Glenn W. Wortmann, MD

    Influenza (or what we commonly call flu) is one of several viruses which can infect the respiratory tract and cause symptoms of runny nose, cough, and nasal congestion (and occasionally more severe illnesses such as pneumonia, which is an infection of the lungs).  However, it’s not the only virus which can infect the respiratory tract. Many such viruses exist in the environment, including those that cause the common cold, such as our usual coronaviruses, rhinovirus, and adenovirus.

    In late 2019, what we tend to call “the coronavirus” appeared in Wuhan, China, and then spread to the U.S. in March 2020. Although we have coronaviruses in the U.S., this was a new strain and was called COVID-19. This severe virus has driven a pandemic that has spurred the worldwide population to adopt face coverings and avoid contact with crowds.

    Although seasonal flu can be serious, it is generally not as dangerous as COVID-19. Most people with flu will feel better after a few days. For some, the infection may move lower, into the lungs, where it can cause pneumonia. This is when flu becomes problematic, especially for the elderly or for patients with underlying medical conditions like asthma, diabetes, and heart or kidney disease.

    Flu Vaccine: Your Best Defense

    New flu virus strains appear each year, so every flu season is a little different. At the low end of the scale, the Centers for Disease Control and Prevention (CDC) estimates an annual 9 million flu cases and 12,000 deaths in the U.S. On the other end of the spectrum, in the winter of 2017–2018, an estimated 45 million cases killed at least 80,000 people, the most deaths from flu in over 40 years.

    With COVID-19 still out there, it’s more important than ever to protect yourself from seasonal flu with a vaccine. Learn more from Dr. Glenn Wortmann. @MedStarWHC via https://bit.ly/2GIaZgJ
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    As medical professionals, we recommend the flu vaccine each year. And this year, with COVID-19 still prevalent and a vaccine not yet available, the stakes are higher. Everyone who can get a flu vaccine should do so. It won’t protect you against COVID-19, but it may save your life if it prevents you from contracting common flu while you’re still at risk for COVID-19.

    In general, the vaccine is recommended for everyone over six months of age. Plus, even if you are perfectly healthy, getting the vaccine helps to protect those around you, particularly if you live or work with young children or the elderly.

    Now is the time to get the flu vaccine—whether by injection or nasal spray—to give your body time to build immunity to the viruses. Your healthcare provider can recommend the best way to have your vaccine administered, depending on your circumstances.

    Can the Vaccine Give Me the Flu?

    We can’t overstate this: it is not possible to get the flu from the vaccine.

    The vaccine is carefully formulated each year to protect against specific viruses that are expected to cause health issues. Patients who receive the vaccine will have a mild reaction of soreness or fatigue for a day or two, the body’s natural response. But there is no way to contract flu from the vaccine. Its safety has been proven over decades.

    The vaccine, of course, will never be 100% effective, because new viruses crop up each year after the vaccine is already manufactured. If a patient contracts flu after a flu shot, it’s likely that one of these newer viruses is to blame.

    Separate and Distinct Diseases

    COVID-19 is still at the forefront, causing illness and death. Fortunately, however, most who contract it do fine. Similar to seasonal flu, age is the greatest risk factor with COVID-19, along with underlying medical conditions. For young and healthy people, the death rate from the novel coronavirus is around 1%. But for patients over 70, the death rate jumps to 20%–30%.

    We must not let “pandemic fatigue” set in just as the weather turns colder and people huddle indoors. If we let our guard down and stop taking precautions against COVID-19, we will likely see an uptick in cases. This has already happened in some states, as well as in Europe.

    Remember: COVID-19 and annual flu are separate and distinct diseases. Having one won’t give you immunity from the other. And yes, it is possible to get both—even at the same time. This makes getting the flu shot a priority, especially if you have any underlying conditions, care for someone at risk, or work in healthcare.

    Preventative Measures Work

    Both COVID-19 and seasonal flu spread the same way—person to person, mostly through the air and also, to a lesser degree, on surfaces.

    Findings from the Southern Hemisphere, where flu season is almost past, suggest that COVID-19 precautions can offer a measure of protection against annual flu as well. A study in Australia found only 33 cases of flu in a study sample of 60,000 people. Chile had a similar result, with just 12 cases in a sample of 20,000 people. These numbers are much lower than average during flu season. Flu cases also dropped dramatically this past spring in the U.S., faster than in prior years.

    This encouraging development coincides with widespread use of masks, physical distancing, and frequent handwashing. It’s strong evidence that COVID-19 precautions may very well protect Americans from annual flu as well.

    Another bright spot is how quickly the biopharmaceutical industry is developing a COVID-19 vaccine. Although it’s been only nine months since this virus emerged, several drug companies have vaccines in development, with many in advanced study. That’s really fast. I am optimistic that a vaccine may be fielded within the next six to nine months. If it works, it could save tens of thousands, if not millions of lives—and may accelerate lifting pandemic restrictions.

    The Unpredictability of COVID-19

    Flu and COVID-19 look very similar in their early stages. Other than the loss of taste and smell that occur with COVID-19, it’s virtually impossible early on to tell the difference without testing.

    COVID-19 differs from other viruses in its unpredictability and its greater potential for severe consequences. Some cases show no symptoms. Some people will be sick for a week or two with high fever, cough, sore throat, and body aches, but will never need hospitalization. Others have a massive immune response that triggers other issues, including lung problems that can turn deadly. We also see people who seem to have a mild case, start to improve, then suddenly deteriorate and come to the hospital in respiratory distress.

    We don’t know exactly why the novel coronavirus affects different people differently, but it’s potentially a combination of factors:

    • The presence of risk factors. The elderly and the obese are at a higher risk of more severe illness, as are those with underlying medical conditions
    • The volume of exposure. Although we don’t know for sure, coming in contact with a small amount of virus may cause less severe illness compared to inhaling a larger quantity
    • Patients’ unique immune responses. For some, the virus puts the immune system into overdrive, spurring more serious repercussions

    Although flu rarely leaves lasting consequences, some COVID-19 patients’ symptoms persist for weeks or even months. Lung and heart damage have been reported. We don’t know why some experience these issues while others do not, but a lot of research is underway.

    Quarantine guidelines also differ. COVID-19 patients remain infectious for longer than flu patients, so the recommended quarantine is a minimum of 10 days, compared to 5–7 days for annual flu. This quarantine period helps protect others.

    Thanks to our decades of experience with annual flu, antiviral drugs like Tamiflu® are readily available by prescription and can be taken at home. But they are not needed by everyone, as healthy individuals tend to recover without treatment.

    COVID-19 is a different story. So far, only two drugs have been shown to help, and only in the hospital setting. Remdesivir, an antiviral that slows down the spread of the virus, can help if administered early enough. Dexamethasone is a steroid that can help to quiet the immune system. Neither is a magic bullet and won’t save the sickest patients, but they’re the drug treatments we have currently, and are usually used when patients require admission to the hospital.

    When to Seek Help

    For both COVID-19 and annual flu, it’s best to isolate yourself to protect others from infection.  Stay in touch with your healthcare provider, continue to take precautions, and remain hydrated—especially if you experience gastrointestinal symptoms.

    The most important warning sign—in both COVID-19 and flu—is difficulty breathing. If you find yourself short of breath or cannot do routine things, like walking to the bathroom or up steps, it’s time to reach out to your doctor.

    All hospitals have ramped up COVID-19 safety protocols, with temperature checks, masks, patient isolation, and other precautions. MedStar Washington Hospital Center has taken many steps to enhance the safety of patients, so there’s no reason to delay care if you or a member of your family is in serious distress.

    A Look Ahead

    We are in a very good position, especially compared to a century ago, when the Spanish flu killed millions around the world. But even with advances in technology, ventilators, and modern medicines, we can’t let our guard down. Until a COVID-19 vaccine becomes widely available, it’s absolutely critical to get the annual flu vaccine and continue taking precautions: covering your face, social distancing, and washing your hands or using sanitizer frequently.

    If we keep doing the right thing, there’s a very good chance we’ll be out of the woods in a matter of months and the pandemic will subside.

    We all want to return to normal. Working together, we can.


    Dr. Allen Taylor (Cardiology) and Dr. Aarthi Shenoy (Hematology/Oncology) join Dr. Wortmann to discuss the impact of COVID-19 on the upcoming flu season.

    Experiencing flu symptoms?

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