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On May 26, our Obstetrician-Gynecologist consultant, Anthony N. Gentile, MD, FACOG, of Indiana and Illinois, discussed endometrial ablation, cancer among men from oral sex, and mini-sling implant for urinary incontinence among women.
Today, our expert introduces us to a state-of-the-art life-saver screening test, a minimally invasive technique in hysterectomy, and a most accurate and helpful genetic testing modality that could offer peace of mind to pregnant women.
Life-saver breast ‘halo’
Imagine a screening test for breast cancer that can screen for the disease years before the cancer is palpable or detectable in a mammogram!
Breast cancer is one of the most common causes of cancer related death in women. More than 70 percent of breast cancers are first detected by the patient and often as a palpable lump. By the time a cancerous lump is palpable or visible in a mammogram, it has been growing in the breast for more than 5 years. More than 90 percent of breast cancers originate in the breast ductal tissues.
On October 6, 2005, the US FDA approved a new Papanicolaou (Pap) test system (Halo Breast Pap, made by NeoMatrix, LLC). This system is designed to collect nipple aspirate fluid (NAF) (somewhat like a breast milk pump) for PAP/cytological evaluation. The collected fluid can be used in the determination of normal, premalignant, and malignant cells.
Abnormal cells in NAF can be seen up to seven years prior to the presence of cancer on mammogram or self-examination. This system is not designed to be a diagnostic test - but rather an aid in breast cancer screening.
HALO uses disposable breast cups to applying heat over a five-minute cycle while simultaneously generating mild compression on both breasts. Near the end of the cycle, gentle suction is used to retrieve ductal fluid. This is the first automated, noninvasive NAF collection device specifically designed for use in a medical office.
Laparoscopic hysterectomy
Included in the advances in surgery is laparoscopic hysterectomy (removal of the uterus), that can now be performed through three small abdominal punctures and then have the patient return home to rest comfortably within 24 hours of the surgery and back to her normal activities in less than a week.
Hysterectomy is one of the most common major surgical procedures performed in the United States with over 600,000 performed annually. Most of these surgeries are performed by making a wide incision (cut) into the abdomen and then manually removing the uterus with clamps, sutures, scalpel and scissors. This technique has changed little over the past 50 years till now.
Laparoscopy is done by inserting a lighted telescope-like instrument (laparoscope) into the abdomen to view the abdominal and pelvic organs. The scope has built-in fiber optic video camera, which allows magnified visualization of the inside of the abdomen and shown on a TV monitor for everybody in the operating room to view. New powered laparoscopic morcellators can cut up large tumors or other tissues into small pieces and pass them out of the abdomen through the small punctures. Laparoscopic coagulating instruments can seal large blood vessels and cut through them without injuring the healthy surrounding tissues. This also allows the surgeon to suture and tie knots while viewing the monitor.
Studies have shown that when LSH is performed by experienced laparoscopic surgeons, there is less blood loss, shorter operative times, comparable complication rates and less scarring when compared to traditional abdominal hysterectomy.
Prenatal genetic test
Today’s advances in medical science have brought pregnant women screening test that uses a single ultrasound of the fetal neck and two samples of maternal blood - performed at the correct intervals in pregnancy--that can predict the risk of a fetus having Down Syndrome or Trisomy 18 with a near 95 percent accuracy. Other birth defects could also be detected early on.
In the United States, for every 100 newborn infants, 2 to 3 are born with major birth defects such as significant mental or physical problems. Birth defects can be caused by inherited genetic/chromosome errors, or caused by exposure to harmful agents such as chemical, drugs, or radiation. For 70 percent of babies born with birth defects, the cause is unknown. The majority of birth defects occur during the first 12 weeks of life. Some birth defects may be detected early in pregnancy with special tests. Many birth defects are only detected at birth and others only much later in a child’s development.
Every mother should be offered prenatal genetic screening, most especially those at higher risk. While most babies born with a birth defect have normal parents, some there are risk factors that predispose the fetus to developing birth defects. For example: if the mother is 35 years old or older when the baby is due or if there is family history or a previous child with birth defects, then the risk of a birth defect in a future pregnancy is much higher.
