Women's Health Screening

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Exercise and Cancer
Cancer is very common; there is a one in eight chance any woman will get breast cancer at some time in her life. Other common types of cancer are colon, skin, cervical, ovarian, uterine, brain, bone, and lymphoma (cancer within the lymph nodes). We are fortunate to have various treatments and cures for many of these cancers, and researchers continue to search for more.

Cancer treatment is stressful on the body and can interfere with a regular exercise plan. It is important to try to maintain a flexible exercise schedule, because it is hard to predict how you will feel or how your body will react. Still, there are many people who stay physically active at moderate levels while being treated with chemotherapy or radiation. In fact, light to moderate exercise has been shown recently to improve survival, decrease uncomfortable side effects and fatigue, and improve appetite, mood, stamina, and energy. Exercise can be difficult at first, as the body can become weak after surgery or treatments. Returning to pre-treatment levels of activity might take anywhere from half the time since treatment started to twice the time.

During treatment with chemotherapy, in particular, there are a few precautions and some measures that indicate you should take a break from exercise until your body is responding better. These include avoiding exercise on days of treatment and mornings of blood tests and avoiding crowded exercise settings and pools where germs can easily spread. Blood levels of potassium and sodium must be close to normal (above 3 and 130, respectively) to prevent heart or muscle problems, and your blood count should include a platelet count more than 25,000 and a hemoglobin of more than 11 to prevent bleeding problems or poor oxygen supply to necessary organs.

Avoid Aerobic Exercise If You Have These Symptoms

• Extreme fatigue
• Confusion
• Fever
• Dizziness
• Bleeding
• Blurry vision
• Irregular pulse or heartbeat
• Light-headedness
• Sudden swelling in an arm or leg
• Nausea or vomiting
• More than three episodes of diarrhea in the past 24 hours
• Unable to eat more than 1,000 calories in the past 24 hours
• Shortness of breath
• Chest pain Chemotherapy treatment in the past 24 hours
• Platelets less than 25,000
• Hemoglobin less than 11
• Sodium less than 130
• Potassium less than 3

On days you cannot exercise for one of the above reasons, consider gentle/beginning yoga with simple sitting or floor postures including breathing and relaxation components. Gentle pilates exercises or stretching classes are usually tolerated as well.

If you have had surgery, check with your surgeon to see when you can safely return to aerobic activity. For breast cancer patients who have had a lymph node resection or mastectomy, lifting on that side is usually not recommended for at least four weeks to prevent lymphedema (arm swelling). You should, however, begin moving the shoulder and arm through its full range within the first week after surgery and continue every day thereafter to prevent scar tissue from forming. Both chemotherapy and radiation cancer treatments can lead to dry, irritated, and sun-sensitive skin. This can be managed and relieved by using sunscreen, covering up with clothing when possible, using ointments liberally to prevent chafing, and using generous amounts of moisturizer. A humidifier can help, as can drinking lots of fluids and eating fruits and vegetables. Exercise also improves skin conditions, as it increases blood flow to the skin.

Tips for Exercising While Recovering from Cancer

• Start with gentle walking or cycling
• Try light exercise three days a week with rest days in between
• Alternate aerobic activity days with stretching and conditioning days
• If you cannot tolerate 20 to 30 minutes, break the sessions into 10 minutes each
• Start low, go slow, and increase gradually—no more than 10 percent a week
• Do not get discouraged if you have a "tired" day—rest and try again tomorrow!
• Make exercise enjoyable with good music, a good friend, or in front of a good TV show

Reproductive Health
There is an entire specialty of medicine devoted just to women—obstetrics and gynecology (OBGYN). Family practitioners also are trained in basic obstetric and gynecological care, although they do not do surgery. Seeing your gynecologist or family practitioner once a year to maintain reproductive health and screen for problems is highly recommended. For women without other health problems, OBGYNs sometimes function as their primary care doctors. However, your health care is more comprehensive if you also have an internist or primary care doctor.

As with all physicians, making an appointment is the best way to get answers to your health questions. This is why it is recommended that you see your OBGYN yearly and your primary health doctor at least once every two years. As a reminder, the following screening questions will help you determine whether you have any issues of possible concern. A "yes" answer to any of the following questions is a sign that you should see your gynecologist or family physician.

Do you have any foul-smelling discharge from your vagina?	YES	NO
Do you have any pain in the pelvis?	YES	NO
Do you have pain when you have sex?	YES	NO
Do you feel any breast lumps?	YES	NO
Do you have any drainage from your breasts?	YES	NO
Do you think you might be pregnant?	YES	NO
Have you missed your period more than twice in the past year?	YES	NO
Do you frequently miss your periods?	YES	NO
Do you have very heavy, painful periods?	YES	NO
Do you leak urine?	YES	NO

For women, preventive health measures include screening tests that rule out the most common types of cancers. Breast cancer, the greatest risk, is usually treatable if diagnosed early. Detection methods now may also include genetic screening, along with mammograms, recommended for women yearly after age 40 or 35 if you have risk factors. Breast self-exams should be done every month a few days after your period, once you have started having regular periods and for the rest of your life. Pap smears are done yearly after the age of 21 or if you are sexually active. After menopause, another screening test important for women is bone density testing; this should be done at least once to establish a baseline level of fracture risk.

If you are between the ages of 14 and 45, you should be getting your period every month unless you are pregnant or starting menopause. Stress, excessive exercise, and illness can cause a skipped period, but if this occurs more than two months in a row, speak with your doctor. Having your period means your hormones are balanced and your body is producing normal amounts of estrogen.

Premenstrual syndrome (PMS) is the occurrence of uncomfortable body changes a few days before your period. Treatment of PMS is based on preventing and relieving symptoms. Prevention strategies include a low-salt diet, low-sugar diet, proper sleep, and plenty of exercise. Calcium supplements, vitamin E, vitamin B6, or magnesium in an extra dose the week before your period can help, and adequate amounts of calcium and vitamins should be taken throughout the month.