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UAB creates integrated program to manage diseases of the pancreas, bile ducts

J. Bart Rose, M.D.

The University of Alabama at Birmingham has established the first multidisciplinary program in the state to treat diseases of the pancreas and bile ducts with the creation of the Pancreatobiliary Disease Center within the School of Medicine.

The center will link medical professionals from across UAB Medicine involved in managing pancreatobiliary diseases, including pancreatic cancers, pancreatic cysts, pancreatitis, bile duct and gallbladder cancers, bile duct injuries and complex benign disease of the bile duct.

“While malignancies of the pancreas and bile duct present their own unique challenges to treatment, so do the litany of benign disease affecting these organs,” said J. Bart Rose, M.D., assistant professor in the Department of Surgery and director of the center. “Both acute and chronic pancreatitis can be very difficult to treat. We have designed an infrastructure to support and treat patients with these diseases with cutting edge techniques and minimally invasive approaches.”

The Pancreatobiliary Disease Center is made up of advanced gastroenterologists, interventional radiologists, medical and radiation oncologists, critical care intensivists, surgeons, pathologists, genetic counselors and specialty support staff.

“Our multidisciplinary approach ensures patients with complex benign or malignant problems involving the pancreas or bile duct will be offered appropriate and modern treatment, in an expedited fashion, all done in conjunction with their local providers,” Rose said.

The pancreas is an endocrine gland that produces important hormones, including insulin. It also aids in digestion by producing several enzymes that function in the small intestine. The bile duct is a system of tubes that carry bile, which is essential for digestion, from the liver. Cancer in these organ systems are among the most deadly and difficult to treat malignancies.

pancreas streamRose said the program will be a statewide referral center. Since pancreatobiliary diseases can be challenging and difficult to treat, many are best seen at a major academic medical center such as UAB, which can provide cutting edge treatments and services that may not be available in local hospitals. UAB also offers access to genetic testing and research opportunities, including participation in innovative clinical trials.

“As a referral center, our role will be to fill the gaps from local medical providers,” Rose said. “UAB will be able to offer the latest in surgical and medical treatment approaches, as well as tumor sequencing. We will also be doing data collection and outcomes research, so we will be able to select the best therapeutic approach for each patient based on the accumulated data available, ensuring that we offer each patient the best option for their situation.”

For more information on the UAB Pancreatobiliary Disease Center, call 1-833-UAB-4PDC (1-833-822-4732).

Whitley receives prestigious lifetime achievement award

Richard Whitley, M.D., Distinguished Professor in the University of Alabama at Birmingham Department of Pediatrics, has been named the 2018 recipient of the Infectious Diseases Society of America’s Alexander Fleming Award for lifetime achievement.

According to the IDSA, the Alexander Fleming Award for lifetime achievement is given “in recognition of a career that reflects major contributions to the acquisition and dissemination of knowledge about infectious diseases.”

“To be recognized by the IDSA, my peers and the infectious diseases community for my commitment to the study and field of infectious diseases is humbling and overwhelming,” Whitley said. “Receiving this prestigious award affirms the commitment I made to the study and development of therapies for emerging diseases, mentoring of fellows, and serving of patients that I have been proud to be a part of and look forward to continuing to do.”

An expert on how antiviral therapies fight infections in children and adults, throughout his four-decade career, Whitley has published more than 373 articles on pediatric infectious diseases, was appointed by President Barack Obama to an advisory panel surrounding preparations for the pandemic flu, served as past president of the IDSA, and treated thousands of patients at UAB and Children’s of Alabama.

He is also responsible for the NIH-funded Antiviral Drug Discovery and Development Center, whose purpose is to discover potential new drugs that could be used to treat infections such as West Nile virus and influenza that routinely infect United States citizens and for which there are limited or no treatments.

Whitley also serves as vice chairman of the Department of Pediatrics, co-division director of Pediatric Infectious Diseases, and associate director of Drug Discovery and Development in the UAB Comprehensive Cancer Center.

Higher rates of leukemia relapse linked to clinical trial enrollment, access to continued care

Julie A. Wolfson, M.D.

According to a study published in Cancer Epidemiology, Biomarkers & Prevention, adolescents and young adults (AYA) ages 15-39 with acute lymphoblastic leukemia (ALL) are more likely to relapse than are their pediatric ALL counterparts ages 1-14, with contributing factors ranging from a lower rate of enrollment in available clinical trials to shorter durations of treatment.

Published by Julie A. Wolfson, M.D., MSHS, assistant professor and member of the Institute for Cancer Outcomes and Survivorship at the University of Alabama at Birmingham and associate scientist in the Cancer Center Control and Population Sciences Program in UAB’s Comprehensive Cancer Center, the study looked at data from 184 patients ranging from ages 1-39 and treated for ALL at City of Hope Hospital from 1990-2010. The analysis covered relapse risk during therapy and after completing therapy for these populations.

In both cases of on-therapy and post-therapy relapses, AYA patients had an increased risk as compared to pediatric patients. Investigators were able to account for clinical factors, along with those related to health care delivery or treatment, including whether they were treated with a “pediatric-inspired” or “adult-style” regimen. Among AYA patients, they found patients had an increased risk of having a relapse while on therapy if they had not been enrolled on a clinical trial. They also found that AYA patients were more likely to relapse after completing therapy if they had received a shorter duration of maintenance or consolidation therapy.

“What this analysis reminds us is how unique this AYA population is, and how they continue to face challenges,” Wolfson said. “We recognize that often AYA patients are treated differently just depending on which hospital door they open. They are sometimes treated like pediatric patients, and at other times like adult patients. There are circumstances when this can affect their outcome, and we want to continue to identify factors that impact this group, the challenges they face and ways we can bridge the gap for AYA patients moving forward.”

As outlined in the study, health care delivery — meaning access to and enrollment in clinical trials — plays a role in the potential for relapse in AYA patients.

Wolfson explains that national guidelines encourage AYA patients with cancer to join a clinical trial whenever possible. The study’s findings support that recommendation, and although it is often challenging to find an open or appropriate study, national research groups are working to expand ways for AYA to participate.

“This, combined with the role of treatment factors such as duration of treatment in relapse of AYA patients, led us to suggest that more attention is needed on factors that inhibit AYA patients from seeking or continuing care, or from having access to innovative therapies,” Wolfson said. “The AYA age range is broad, but what is common among these patients is they are often at a place in life that poses unique challenges related to relapse, including being uninsured, under-insured or in a fragile socioeconomic place.”

Future studies will help researchers identify additional areas that need to be addressed in order to support long-term survival rates for AYA patients, as well as ways to maximize treatment options and retention.

Join in on activities this October as part of Breast Cancer Awareness Month

Breast cancer is the most common cancer in American women other than skin cancer. Many factors influence breast cancer risk, but the main one is simply advancing in age. Being familiar with how your breasts look and feel can help you notice symptoms such as lumps, pain or changes in size that may be of concern. You should report any changes you notice to your doctor or health care provider. Mammograms are the best way to find breast cancer early, when it is easier to treat and before it is big enough to feel or cause symptoms.

The Breast Cancer Research Foundation of Alabama has raised more than $7.7 million to support cancer research at the University of Alabama at Birmingham Comprehensive Cancer Center. The BCRFA helps ensure physicians and scientists can seize every opportunity for groundbreaking discovery and bring them directly to their patients.

In honor of October’s being Breast Cancer Awareness Month, the BCRFA and other local organizations are hosting many events in and around Birmingham.

Sept. 10: Full Moon Bar-B-Que’s Half-Moon Cookies for a Cause
Beginning Sept. 10, the iconic half-moon cookie tins have gone pink, and $1 from every pink tin of cookies will be donated to BCRFA. All money raised through the fundraiser will then be matched by Coca-Cola Bottling Co. Order cookies at fullmoonbbq.com/bcrfa-cookie-tin-drive.

Sept. 24-29: Wrapsody Hoover Breast Cancer Event
Donate $5 to Wrapsody’s Wrapped in Hope Raffle for a chance to win a $250 gift card. Also, 10 percent of sales and 100 percent of raffle proceeds will be donated to the Angel Squad at UAB’s Kirklin Clinic.

Sept. 30: Revvin’ 4 Research Charity Motorcycle Ride
Join Heart of Dixie Harley-Davidson for the 10th annual “Revvin’ 4 Research” Charity Ride, benefiting BCRFA. Registration begins at 11 a.m. at Heart of Dixie Harley-Davidson in Pelham, with kickstands up at 12:30 p.m. The escorted ride will offer lunch, provided by Courtyard Oyster Bar, before departure and an after-party with live music at the Yellow Rose. Register online at revvin4research.com or call 205-996-5463.

October: Cahaba Brewing Goes Pink for BCRFA
During the entire month, stop by Cahaba Brewing Company anytime and support them as they go pink to support BCRFA. Cahaba Brewing will have a tart cherry and hibiscus Berliner Weisse specially brewed for the month, as well as navy and pink Cahaba Brewing Co. T-shirts, with a percentage of proceeds from both benefiting BCRFA.

October: The Cowfish’s TataTinis
Be sure to dine at The Cowfish Sushi Burger Bar and order a TataTini throughout October. The Cowfish is donating $2 from every specialty pink martini to BCRFA.

October: Pink Ribbon Project
Fire stations across the state will Go Pink! to support breast cancer research in Alabama throughout the month of October. More than a dozen stations across Alabama will be selling specially designed Pink Ribbon Project T-shirts for $15 and $20. Proceeds from shirt sales will help the BCRFA provide seed dollars required to secure national grants for breast cancer research at the UAB Comprehensive Cancer Center.

October: Tameron Automotive Breast Cancer Awareness Campaign
Tameron Automotive Group will donate $100 in support of breast cancer research for every new car sold during the month of October at Tameron Honda (1675 Montgomery Highway, Birmingham) and Tameron Hyundai (1595 Montgomery Highway, Birmingham).

October: Renasant Bank Fundraising Campaign
Renasant branches statewide will hold fundraisers for the BCRFA, and accept donations from their account holders throughout the month of October. Renasant Mortgage will donate $25 for every mortgage closed in October with Renasant. Click here to find your local Renasant Bank Branch.

Oct. 2: BCRFA’s Go Pink! T-shirt Sale
Short- and long-sleeved T-shirts will be available for sale Tuesday, Oct. 2, from 10 a.m.-5 p.m. and Friday, Oct. 5, from 9 a.m.-2 p.m. in the second floor Atrium of the North Pavilion Building at UAB. Short-sleeved shirts are $15, and long-sleeved are $20. Proceeds go to fund research and save lives. Click here to see T-shirt designs.

Oct. 5: Jim ‘N Nick’s Angel Squad Breast Cancer Awareness Day
UAB’s Angel Squad members will be present in Jim ‘N Nick’s restaurants throughout the Birmingham area from 11 a.m.-2 p.m. to promote breast cancer awareness and the importance of early detection with mammograms by distributing informational brochures, pink ribbons, bracelets and stickers throughout the day. They will also be selling Jim ‘N Nick’s gifts cards for $10; half of the proceeds will go to the Angel Squad to support breast cancer patients, including assisting navigators in the Breast Health Center and Diagnostic Mammography at The Kirklin Clinic of UAB Hospital.

Oct. 6: The Patsy Pull in Downtown Collinsville, Alabama
Gather a team of eight to see if you have what it takes to pull a fully loaded fire truck 40 feet. The fastest time will take home bragging rights, all in support of BCRFA. Enjoy live music, good food, inflatables, door prizes and halftime competitions. Find more information on Facebook at The Patsy Pull.

Oct. 12: Pink Luncheon Benefiting BCRFA
This year’s 10th annual luncheon theme is all about getting your groove on and “Stayin’ Alive.” Make a minimum donation of $25 to BCRFA, and head over from 11 a.m.-2 p.m. to enjoy a buffet and prizes at the MSE Building Co. (5500 Derby Drive, Birmingham). RSVP at 205-833-9010.

Oct. 11: Charity Shopping Event at Kendra Scott at The Summit
Kendra Scott at The Summit will have a charity shopping event from 5-7 p.m., with a percentage of sales benefiting BCRFA.

Oct. 12-21: Calera Goes Pink!
Join the City of Calera as they “Go Pink” to support breast cancer research in Alabama. This citywide event kicks off with the Calera High School football game on Friday, Oct. 12, and a golf tournament at Timberline on Sunday, Oct. 21. For details on how you can get involved, call BCRFA at 205-996-5463.

Oct. 13: Susan G. Komen North Central Alabama Race for the Cure
The Susan G. Komen Race for the Cure is the largest series of 5K run/fitness walks in the world. The local race will begin at Regions Field in downtown Birmingham. Race-day registration and packet pickup will begin at 7 a.m. The parade will be at 8 a.m., the 5K starts at 9:15 a.m., and the 1-mile fun run/walk is at 9:45 a.m. Detailed information and registration is available online.

Oct. 19: Rock Creek Pharmacy “Shot for Cure”
Rock Creek Pharmacy in Bessemer, Alabama, (6817 Warrior River Road, Suite 101) will donate $5 to BCRFA for every flu shot given that day.

Nov. 17: CrossFit Chelsea’s Fight Like a Girl
Head out to CrossFit Chelsea to “Fight Like a Girl,” a two-person, mixed-gender CrossFit team event raising funds and awareness for BCRFA.

Analysis assesses current end-of-life care treatment for stem-cell transplant patients

For many cancer patients, high-intensity treatments such as intubation and ICU admission are administered during their end-of-life care, but little is known about whether that care is in line with a patient’s wishes and treatment goals. In an analysis recently published in the Journal of Clinical Oncology, data was collected from patients who died within one year of receiving a stem cell transplant to better understand what end-of-life for these patients entails and how it can be improved upon to ensure that a patient is dying in the way they would like.

Emily Johnston, M.D., assistant professor in the University of Alabama at Birmingham Division of Pediatric Hematology-Oncology and member of UAB’s Institute of Cancer Outcomes and Survivorship, was the lead author.

“From our data, we understand there is a correlation with high-intensity end-of-life care in patients who die within one year after receiving a stem cell transplant, but we are still unsure if that was the care they wanted,” Johnston said. “As oncologists, we need to better understand a patient’s wants — what are their end-of-life goals? Do they want to undergo further treatment or return comfortably home? Improving end-of-life care is the goal, and we need to make sure that care is what the patients want.”

According to the study of more than 2,100 pediatric and adult patients, the most common end-of-life care high-intensity treatment included 83 percent dying in the hospital, 49 percent being admitted to the intensive care unit and 45 percent undergoing intubation. High-risk groups identified in the study included patients ages 15-21 and 30-59, patients with acute lymphoblastic leukemia, and patients with comorbidities at the time of their stem cell transplant.

However, the data does not indicate the patient’s preference in their high-intensity end-of-life care. As Johnston explains, better understanding patient goals, how caregiver outcomes are affected by the intensity of end-of-life care, and the added expense associated with high-intensity medical care at this phase of a patient’s life is what needs to determine how patients want to spend their remaining time.

Further, quality markers for pediatric end-of-life care need to be developed to understand how to best care for children who are dying.

“The findings suggest that, as oncologists, we need to start having end-of-life care conversations earlier with patients to determine if a high-intensity treatment plan is consistent with their goals, or if a lower-intensity treatment plan is best; it’s not a one-size-fits-all approach in end-of-life care,” Johnston said. “My hope is that, through continued studies, we can better give patients the opportunity to die in the location they want after receiving care that is consistent with their end-of-life goals.”

Matt Might to give Birmingham keynote for Biden Cancer Summit

Matt Might, Ph.D.

The University of Alabama at Birmingham and UAB’s School of Nursing  will host Friday’s Biden Cancer Summit  event in Birmingham to coincide with the national summit taking place in Washington, D.C., and in cities around the country.

Matt Might, Ph.D., director of UAB’s Hugh Kaul Precision Medicine Institute , will give the Birmingham keynote presentation on the groundbreaking work that UAB and the UAB Comprehensive Cancer Center  are engaging in to identify and treat cancer — and the work that must still be done.

The event, which is free and open to the public, will be at 11 a.m. Friday at the UAB School of Nursing, located at 1701 University Blvd., Birmingham, in Room NB 1054.

Representatives from the American Cancer Society, Children’s Hospital, Ronald McDonald House and other organizations will also be on hand to showcase volunteer opportunities.

Former Vice President Joe Biden and Dr. Jill Biden will host the national Biden Cancer Summit  to focus on the patient’s journey from prevention through a cancer diagnosis, treatment through survivorship, and determine what must be done to accelerate progress. The summits are meant to draw attention to the progress doctors and scientists have made in treating cancer, and to highlight the work that still needs to take place.

From 2016 to 2018, Might was a strategist in the Executive Office of the President in The White House. At The White House, Might worked primarily on President Barack Obama’s Precision Medicine Initiative with both the National Institutes of Health and the Department of Veterans Affairs. Prior to this role, he was a faculty member in the Department of Biomedical Informatics at the Harvard Medical School. At Harvard, Might’s research focused on rare disease discovery and diagnosis, and on the development of personalized therapeutics for rare disease.

At UAB, Might’s NIH and philanthropically funded research focuses on precision prevention, diagnosis and therapeutics across rare disease, cancer, and common/chronic conditions. A principal theme in his research is the use of computer and data science to enhance clinical and academic medicine.

Learn more about UAB’s Precision Medicine initiative — including more on Might’s incredible journey from computer scientist to identifying and treating his son’s potentially fatal disease — by visiting UAB’s Precision Medicine website.

UAB receives $11.7 million grant to test weight loss intervention for cancer survivors

Wendy Demark-Wahnefried, Ph.D., R.D.

Researchers with the University of Alabama at Birmingham have received a five-year $11.7 million grant from the NIH and National Cancer Institute to test effective and scalable diet and exercise interventions among underserved cancer survivors in Alabama, Mississippi, North Carolina and Tennessee.

“Cancer survivors age 60 and older are an at-risk population for obesity, functional decline and many other chronic diseases after their cancer diagnosis,” said principal investigator Wendy Demark-Wahnefried, Ph.D., R.D., professor and Webb Endowed Chair of Nutrition Sciences. “This grant allows us to target older individuals who may be at risk and help them to have better lives post-cancer.”

Researchers from the schools of Health Professions and Public HealthDivisions of Hematology and Oncology and Preventive Medicine, and the UAB Comprehensive Cancer Center will all be part of the intervention efforts.

Demark-Wahnefried says she and her team will be recruiting 652 participants across four states for three separate initiatives that test three distinct diet and exercise interventions — for the program titled “Adapting MultiPLe behavior Interventions that eFfectively Improve Cancer Survivor Health,” or AMPLIFI. The interventions will be web-based and assessments will take place in the field, so researchers can monitor participants from miles away.

This study will be a multidisciplinary effort including faculty members from across UAB’s campus. Other team members include Laura Rogers, M.D., Dori Pekmezi, Ph.D., Maria Pisu, Ph.D., Robert Oster, Ph.D., Kelly Kenzik, Ph.D., Natalya Ivankova, Ph.D., Yumei Schoenberger-Godwin, and Kevin Fontaine, Ph.D., all of UAB; and Michelle Martin from the University of Tennessee Health Science Center.

Recruiting will begin soon. For more information, please call 205-975-4022.

Ketogenic diet reduces body fat in women with ovarian or endometrial cancer

Kevin Fontaine, Ph.D.

Women with ovarian or endometrial cancer who followed the ketogenic diet for 12 weeks lost more body fat and had lower insulin levels compared to those who followed the low-fat diet recommended by the American Cancer Society, according to a new study published by researchers at the University of Alabama at Birmingham.

The study, A Ketogenic Diet Reduces Central Obesity and Serum Insulin in Women with Ovarian or Endometrial Cancer, was published in the Journal of Nutrition.

Researchers studied 45 overweight or obese women with ovarian or endometrial cancer. The participants were not actively attempting to lose weight and were not on special diets at the time of enrollment. Each was randomly assigned to either the ketogenic diet or the American Cancer Society-recommended diet.

“Compared to the diet recommended by the American Cancer Society, which is moderate- to high-carbohydrate, high-fiber and low-fat, 12 weeks on a ketogenic diet, which is low-carbohydrate, high-fat, produced significantly lower levels of fat mass,” said Kevin Fontaine, Ph.D., co-author of the study and chair of the Department of Health Behavior in the UAB School of Public Health. “The ketogenic diet group also had significantly lower levels of fasting insulin.”

Researchers decided to focus on women with ovarian and endometrial cancers based on the cancers’ health outcomes and risk factors.

“Ovarian and endometrial cancers are some of the deadliest cancers among women in the United States,” Fontaine said. “These cancers are also strongly linked to obesity and higher levels of insulin.”

The ketogenic diet was used because it limits the number of carbohydrate foods that are consumed, foods that increase glucose and insulin.

“Because cancer cells prefer to use glucose, diets that limit glucose may be beneficial,” said Barbara Gower, Ph.D., senior author and professor in the School of Health Professions at UAB. “These diets are called ‘ketogenic’ because they allow the body to burn fat as a fuel. Some of the fat is converted to ketones, which are used by the brain and many other tissues as another type of fuel. Because they limit glucose and several growth factors, ketogenic diets will limit the ability of cancer to grow, which gives the patient’s immune system time to respond.”

In previous animal and small-scale human studies, the ketogenic diet has been shown to affect the development and health outcomes of cancer. This study showed that the diet had a number of favorable effects in women with ovarian or endometrial cancer.

“First, it lowered insulin, which is a growth factor,” Gower explained. “High-glucose diets result in high insulin, which stimulates cancer cell growth. Second, this ketogenic diet resulted in selected loss of visceral fat. Visceral fat is the ‘bad fat’ in the abdomen that is associated with elevated risk for cancer and diabetes. Third, we noted that patients with higher ketones had lower levels of IGF-1. IGF-1 is also a growth factor that stimulates cancer cells.”

While the study’s findings show the benefits of the ketogenic diet in cancer patients, the study authors hope to continue to expand their research to see if it impacts cancer treatment too. Both Fontaine and Gower are senior scientists in the UAB Comprehensive Cancer Center.

“We hope to acquire additional grant funding so we can conduct a larger study that begins the diet right at the time of diagnosis so we can better estimate its effects on treatment, prognosis and survival,” Fontaine said.

Ending the confusion about breast cancer screening: Annual mammograms starting at 40 save the most lives

“Studies have shown that being screened annually results in more lives saved from breast cancer than screening every other year.”

Breast cancer is the most common cancer in women in the United States, according to the Centers for Disease Control and Prevention. That is why having an annual mammogram beginning at age 40 is the best way to prevent deaths from breast cancer.

Breast imagers at the University of Alabama at Birmingham School of Medicine explain when and why women should have mammograms, what having a mammogram feels like, and the risk factors women should be aware of when it comes to breast cancer.

When should women get mammograms?
“All women with no special risk factors should start having annual mammograms at age 40,” said Caroline Reich, M.D., Ph.D., breast imaging medical director in the Department of Radiology at UAB. “About 20 percent of the cancers found in asymptomatic women are in individuals between the ages of 40 and 49. To me, this is one of the biggest reasons to start having mammograms at 40.”

Reich adds that the cancers found in premenopausal women tend to be more aggressive than those found in postmenopausal women.

“Studies have shown an increase in breast cancer incidence in women at and beyond the age of 40 with statistically significant reduction in mortality among those women screened starting at age 40,” said Lawrence Manalo, M.D., Ph.D., a breast imager at UAB.

Why should women have annual mammograms? Why not every other year?
“The benefits of a yearly screening mammogram far outweigh the risks,” Manalo said. “Detecting cancer while it is small and hasn’t had a chance to spread and getting treated appropriately significantly improve a woman’s mortality.”

Manalo adds that most breast cancers are sporadic and are detected in women of average risk, including women with no family history of breast cancer.

The largest and longest-running breast cancer screening trials in history have reconfirmed that regular mammography screening cuts breast cancer deaths by roughly one-third of all women age 40 and over, according to the American College of Radiology and the Society of Breast Imaging.

“Annual mammography screening saves lives,” Reich said. “Studies have shown that being screened annually results in more lives saved from breast cancer than screening every other year.”

Why are some women reluctant to have mammograms?
One reason some women may avoid having mammograms is the fear that it will hurt from the compression.

“I think patients worry about discomfort and are scared of the compression, especially those women who have never experienced a mammogram before,” Reich said. “However, with every generation of new technology, adjustments are being made to make patients more comfortable and make the procedure less intimidating. New technology has enhanced the design of mammography machines to minimize discomfort and make the screening faster.”

“It is important to educate women that having their breasts compressed appropriately aids in cancer detection due to less overlap or superimposed normal breast tissue that can hide cancers,” Manalo said.

Reich says exposure to radiation is another concern she hears from her patients.

“There is a perception that you will be exposed to a high amount of radiation, but that is not the case,” Reich explained. “The amount of radiation a woman receives during a screening mammogram is the equivalent to what they receive from background radiation walking around for a seven-week period. The benefits of early detection far outweigh the risks of such a small amount of radiation.”

Anxiety about finding a cancer is also a factor that may deter women from annual screenings.

“Anxiety, especially in women with a history of breast cancer or a family history, can be overwhelming for patients,” said Stefanie Woodard, M.D., a breast imager at UAB. “Our technologists are excellent at comforting patients during their exams. We want patients to feel confident and supported when they come for their screenings.”

What happens during a mammogram?
During a mammogram, a technologist will walk you through the process, then assist you throughout the screening by positioning your breast for each image.

“We take anywhere from four to six images of the breast,” said Tricia Reed, a mammography technologist at UAB. “There will be some compression, but it is not as bad as what patients typically expect.”

As for the compression, Reed says the purpose is to take the best image of the breast tissue. Each compression lasts for about10 seconds per image.

“The tighter the compression, the better images we can get from you so the doctor can see more tissue,” Reed explained. “The breast is made up of fibroglandular and fatty tissue, and if we don’t spread it out, you can’t see clearly through the tissue.”

The technologists will take images of the breasts from top to bottom, the sides and the lymph nodes.

“A lot of people don’t realize that your breast tissue goes under your arm,” said Kernesha Weatherly, manager of Breast Imaging at UAB. “This image gives us the best picture of the lymph nodes and muscle tissue where cancers may be found.”

Patients who are active portal members will receive the results within 24 hours of their images’ being read.

What does it mean if I receive a breast density notification? 
Alabama has a breast density notification law, meaning health care providers are required by law to tell patients if 50 percent or more of their breast tissue is dense.

“A lot of people become nervous when they hear they have dense tissue,” Weatherly explained. “The notification does not mean there is a problem. It is only because it is a state requirement.”

However, dense breast tissue may make it harder to find cancer on a mammogram, which is why women with dense breasts may benefit from digital breast tomosynthesis or semi-3D mammography in addition to clinical breast examinations.

Who is more at risk for breast cancer?
Simply being a woman is the main risk factor for breast cancer, according to the American Cancer Society. Men can get breast cancer too, but the disease is about 100 times more common in women than in men.

While a family history of breast cancer plays a role in the risk, it does not mean you are in the clear if you do not have a history of the disease.

“The majority of women who get breast cancer do not have a family history,” Reich said. “However, people with a family history have a greater chance of developing breast cancer, particularly if someone has a mother or a sister who developed pre-menopausal breast cancer.”

If you do have an immediate family history of the disease, meaning a mother or a sister has had breast cancer, particularly at an early age, Reich suggests that you discuss this with your doctor to see if you should begin screening before age 40.

How can I schedule a mammogram at UAB?
To schedule a mammogram, contact the UAB HealthFinder line at 800-822-8816. You may also request an appoint online.

UAB offers mammography screening at The Kirklin Clinic and at UAB Medicine Leeds. Breast imaging will also be offered at UAB’s Gardendale clinic once it opens next year.

Gynecologic cancers – early detection and understanding symptoms can save lives

In 2017, more than 107,000 new cases of gynecologic cancers were diagnosed in American women. Of those, an estimated 31,600 women lost their fight with a gynecologic cancer.

However, many women are unaware of their potential risk for developing a gynecologic cancer and the symptoms that indicate they may have cancer.

What is gynecologic cancer? 
According to the Centers for Disease Control and Prevention, gynecologic cancer is any cancer that starts in a woman’s reproductive organs. The five primary gynecological cancers include ovarian, cervical, vulvar, uterine/endometrial, and vaginal, all posing unique symptoms and risk factors.

“Most people who get a gynecologic cancer don’t have obvious risk factors,” said Warner K. Huh, M.D., division director of the University of Alabama at Birmingham Division of Gynecologic Oncology. “With these types of cancers, what women can control is being screened regularly and seeking medical advice if something doesn’t seem right with their bodies.”

Any woman can be at risk for any gynecologic cancer. Risk tends to increase with age, and there is always a heightened possibility of cancer due to family history or race. Lifestyle choices such as chronic smoking and obesity can impact one’s risk for developing a gynecologic cancer; for instance, there is a correlation between higher rates of uterine/endometrial cancers in obese women.

Signs and symptoms
A primary challenge in the detection of gynecologic cancers is that many of the signs and symptoms are ones that women experience regularly, be they with menstruation or as side effects from another condition. Furthermore, symptoms range from woman to woman, so it can be hard to definitively say that each woman will experience the same thing.

“What women need to be looking for is the chronicity and abnormal frequency of symptoms, even if the symptoms are ones that don’t seem out of the ordinary,” said Huh, who is also the senior medical officer for the cancer service line at the UAB Comprehensive Cancer Center. “If they are experiencing symptoms like persistent bloating, ongoing bleeding or persistent pelvic pain, they need to be aware of the persistence and length of these symptoms as they may indicate that a formal medical evaluation is needed.”

While each woman’s reaction may be different, the signs and symptoms below are general indicators for each cancer. As Huh notes, it is important for women to use these symptoms as guides, ultimately knowing that they are the only ones who know for certain that there is something atypical, uncomfortable or intolerable about the symptoms they are experiencing.

  • Cervical: vaginal bleeding unrelated to one’s period; postmenopausal bleeding; pain or bleeding during intercourse; significant or foul-smelling discharge
  • Ovarian: loss of appetite or feeling full quickly; gas; bloating; nausea; frequent urination; pelvic pain or pressure
  • Uterine/Endometrial: postmenopausal bleeding; irregular bleeding between menstrual cycles; heavier and/or longer menstrual bleeding; pelvic pain
  • Vaginal: postmenopausal bleeding; pain or bleeding during intercourse; pelvic pain and constipation; vaginal mass
  • Vulvar: constant itching and/or burning sensation in the vulva (outer part of female genitals); change in skin color of the vulva, including rashes, sores or warts

Prevention and detection
Women undergo different screenings at their annual OBGYN appointment — screenings that can ultimately save their lives if they are positive for cancer. Both the Pap test and HPV test are routinely administered at an OBGYN visit and are conducted during pelvic exams by means of cell collection with a swab.

The Pap test — often referred to as a Pap smear — tests for cervical cancer through the collection of cells from the cervix. The test not only can detect active cancerous cells but can detect changes that may identify a risk for cancer in the future. The Pap test does not screen for cancers beyond cervical. Women as young as 21 will undergo routine Pap tests in their annual OBGYN visit, and their doctor may suggest a schedule for Pap tests moving forward, such as getting one every three years.

The HPV test is similar to the Pap test in the way cells are collected, but it tests more broadly for other types of cancers and human papillomavirus. The current recommendation is that women 30 years and older receive an HPV test in addition to the Pap test at their annual visit.

“We know that, with most malignancies, screening is critical and early detection can help save the life of the woman,” Huh said. “The biggest takeaway for women is to stay mindful of their bodies, report any symptoms that appear even remotely irregular and make sure they have their screenings conducted on a yearly basis. These actions can ultimately save their life.”

What about the HPV vaccine?
Huh strongly advises that all women — and men — receive the vaccine to protect against cancers caused by human papillomavirus. The recommendation is for girls and boys starting as young as age 9 up until age 26 to receive the required dosages. In women, the HPV infection can cause cervical, vaginal and vulvar cancers, so the vaccine provides added protection for this population.

If you or a woman you know is experiencing abnormal symptoms, talk to your doctor about what you are feeling. Pay attention to your body and know what is or is not normal for you.