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Commonly asked questions & answers about screening tests.

Q I am 33 years old and had my second child five months ago. I just haven't been myself ever since. I can't seem to lose the baby weight, even though I'm breastfeeding and exercising. I feel really tired, down and cold all the time. I don't remember feeling like this after my first pregnancy. Could there be something wrong with me?

A All of your symptoms could be related to the birth of your second child. However, they could also be related to a sluggish thyroid gland that isn't putting out enough thyroid hormone. This condition is called hypothyroidism, and it often appears during or after a pregnancy. All women 35 and older should be screened for hypothyroidism every five years. But you should ask your doctor to screen you now with a TSH test. This test measures a hormone that your pituitary gland releases that, in turn, tells your thyroid to release thyroid hormone. If you have hypothyroidism, your TSH level will be increased. In that case you will need supplemental thyroid hormone, typically thyroxine, which will raise your thyroid level to normal and should make you feel well again.

--Lawrence Wood, MD

CEO and Medical Director

Thyroid Foundation of America

Boston, MA

Q I've read that there's no benefit to eating a high-fiber diet when it comes to preventing colon cancer. Can I go back to white bread and rice?

A For years, we thought--and population-based studies suggested--that high-fiber diets helped prevent colon cancer. But a more recent study in which researchers tracked the eating habits of more than 88,000 female nurses over 16 years found that women who ate a high-fiber diet were just as likely to develop colorectal cancer or polyps as women who ate little fiber. (33) However, there are a few caveats with this study. The women were asked to recall what they ate--always iffy in terms of accuracy. Also, other things in their diet, particularly sugar, may have affected the results. Finally, some studies find greater benefits based on age. Regardless, do not cut back on fiber; it's healthy in many other ways, including reducing cholesterol levels, helping control weight and reducing the risk of diabetes.

--David Stein, MD

Assistant Professor

Division of Colorectal Surgery

Drexel University College of Medicine

Philadelphia, PA

Q The mammogram center across town is advertising that it uses computer-aided detection (CAD) software to identify suspicious findings. Should I switch mammography centers?

A Computer-aided detection software analyzes mammogram images and marks suspicious areas for radiologists to review along with their own readings. Although it might sound like CAD would improve readings, a major study from the National Cancer Institute found no difference in breast cancer detection rates in facilities before and after using CAD. In fact, although the biopsy rate increased nearly 20 percent with the use of CAD, its use significantly reduced the accuracy of mammogram readings. (31) Stick with the mammogram center you're most comfortable using.

--Ari Brooks, MD

Associate Professor

Department of Surgery

Drexel University College of Medicine

Philadelphia, PA

References

31 Fenton JJ, Taplin SH, et al. Influence of Computer-Aided Detection on Performance of Screening Mammography. NEJM, Vol. 356, No. 14. Apr 5, 2007

32 Ravdin PM, Cronin KA, Howlader N, et al. The decrease in breast cancer incidence in 2003 in the United States. N Engl J Med. 2007;356:1670-1674.

33 Fuchs CS, Giovannucci EL, Colditz GA, Hunter DJ, Stampfer MJ, Rosner B, Speizer FE, Willett WC. Dietary fiber and the risk of colorectal cancer and adenoma in women. N Engl J Med. 1999Jan 21;340(3):169-76.
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Title Annotation:ASK THE EXPERT
Publication:National Women's Health Report
Date:Dec 1, 2007
Words:597
Previous Article:Women & cervical cancer screening.
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