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Maternal obesity
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
D. Yvette LaCoursiere, Thomas R. Moore
A management plan for obese pregnant women is included in Table 8. Acknowledging that half of pregnancies are unintended, the discussion about appropriate weight during pregnancy and consequences of obesity should begin at the well-woman examination. Currently, only one-quarter of providers address weight among overweight and obese women at annual examinations (58). Documentation of BMI should be performed and overweight and obese patients should be referred to available PA and nutrition counseling. Women who are contemplating pregnancy should be encouraged to take folic acid as obesity is a risk factor for inadequate folic acid supplementation. Also they should be educated regarding the increased risks that obese women and their infants experience and screened for diabetes.
Breast cancer genetics and risk assessment: an overview for the clinician
Published in Climacteric, 2023
Although a clinical breast examination is part of the standard well woman examination in the USA, model-calculated breast cancer risk assessment is not standard, and there are no guidelines to support risk assessment as part of an annual preventative visit. In the USA, the American College of Radiology (ACR) issued a recommendation in 2018 that all women be evaluated for breast cancer risk by age 30 years, especially black women and those of Ashkenazi Jewish descent, to identify high-risk women who would benefit from supplemental screening before age 40 years [52]. The ACR recommendations include a review of the available risk assessment tools but do not specify the risk assessment tool to be used to assess risk. In 2019 the American Society of Breast Surgeons (ASBS) updated their mammography screening guidelines to include breast cancer risk assessment [53], stating that ‘all women aged 25 and older should have a formal risk assessment for breast cancer’. The ASBS defined risk assessment to include family history, screening for prior chest radiation and screening for the need for genetic testing based on the NCCN guidelines. For women aged 30 years or above, the ASBS added risk assessment using the Tyrer–Cuzick model version 8 that incorporates breast density [53]. Without clear guidelines recommending risk assessment for all women, broad adoption is unlikely. However, when risk assessment tools are generally applied to women in developed countries between age 40 and 60 years, nearly 25% of women will be identified to be at ‘high risk’, as defined by a lifetime risk over 20%. Without guidelines and broad adoption of risk assessment, most high-risk women will remain undetected; for women at calculated high risk, defined as a risk calculated lifetime risk of more than 20%, US guidelines (U.S. Preventative Services Task Force (USPSTF), NCCN, American Cancer Society (ACS), ACR ASBS) [54] and guidelines of the European Society of Breast Imaging (EUSOBI) [54] and European Society of Breast Cancer Specialists (EUSOMA) [54] recommend supplemental screening with breast magnetic resonance imaging regardless of breast density, and the opportunity to educate them about lifestyle for risk reduction, enhanced screening, genetic testing and chemoprevention when appropriate is missed.