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6 minutes ago
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Mastectomy or Lumpectomy? Reassuring New Data for Young Women
July 23, 2025 – Young women diagnosed with breast cancer may not need to choose aggressive surgery to reduce recurrence risk. New research suggests the likelihood of cancer recurring (coming back) in the same breast or nearby lymph nodes isn't related to her choice of surgical treatment – removing either the cancerous tissue (lumpectomy) or one or both breasts (mastectomy). And for women 40 and under with invasive but not incurable cancer, recurrence risk across the board was "low" – just 5.6% over 10 years. "Many young women with breast cancer choose to have bilateral mastectomies even if they may be a candidate for a smaller surgery," said study author Laura S. Dominici, MD, a breast surgeon at Dana-Farber Cancer Institute and Mass General Brigham in Boston. "We know survival isn't impacted by this choice, but historically, young women were felt to have higher risk for local recurrence and tend to have more 'aggressive' breast cancers." The new findings, published Wednesday in JAMA Surgery, suggest that "women cannot make a bad choice," Dominici said. "A woman who wants to keep her breast isn't trading off a cancer outcome to do so." Of the more than 1,100 people in the study, 30% had lumpectomy, 26% had a single mastectomy, and 43% had bilateral mastectomy. When researchers analyzed surgical treatment alongside cancer subtype – such as whether it was related to hormones or certain genes – they found no significant differences in recurrence rates. Researchers attributed the low risk to advances in cancer treatments, which have become more targeted. Breast cancer patients in the study were diagnosed between 2006 and 2015, and they received optimal treatment after surgery – meaning breast cancer in young women may not be as likely to come back as older research suggested. Does This Research Apply to Me? The study included women age 40 or younger with stage I, II, or III breast cancer of any subtype – meaning hormone receptor-positive, triple negative, or any ERBB2 (formerly HER2) genetic status. If that describes you, you may want to talk to your doctor about it. The researchers excluded women with stage IV breast cancer (which has already spread to other parts of the body) and women with stage 0, or ductal carcinoma in situ or DCIS. "The results do require some caution in their generalizability because the patients were not from diverse populations, with nearly 85% non-Hispanic White women," Julie A. Margenthaler, MD, wrote in a commentary published with the study. Margenthaler was not involved in the study and is a breast cancer surgeon at WashU Medicine in St. Louis. What Type of Recurrence Did This Study Look For? It looked for local or regional recurrence (that is, in the same breast or surrounding lymph nodes), but not distant recurrence – when breast cancer returns in a distant part of the body like the brain or bones. That's a stage IV diagnosis, which is usually considered treatable but not curable. What About BRCA? About 1 in 10 women in the study had known BRCA genetic involvement, and most had mastectomies. "Women do not have to have a mastectomy in this setting, but many of them consider it," Dominici said. "Mastectomies will reduce the risk for future cancers (for which patients with BRCA mutations are at higher risk) but will not reduce risk for recurrence of the current cancer. A woman with BRCA mutation having lumpectomy should be doing high-risk screening with mammogram and MRI." Does This Mean I Should Get a Lumpectomy? When deciding what breast cancer surgery to have, you need to consider physical, emotional, and psychological factors, said Dominici, who is also a professor at Harvard Medical School. "There is no 'right' answer," she said, "and it is often hard for women to both appreciate and consider the short- and long-term impacts of the different surgeries." Lumpectomy may not be an option for some women with cancer in a significant portion or multiple areas of the breast, Dominici said. "Surgery is one important part of treatment, but systemic therapy and radiation are also key to lower risk for recurrence," she said.
WebMD
2 days ago
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How I Prep for Big Life Moments When My Skin Isn't Cooperating
Last month, I flew to Brazil for a trip I'd been planning for months. It was meant to be a getaway full of joy, beach days, sightseeing, and reconnecting with friends. What I didn't plan for was having an eczema flare-up days before my flight. The timing couldn't have been worse. My skin was irritated and inflamed, and I was concerned about what a long flight, sun exposure, and unfamiliar products might do to my already flaring skin. I thought about canceling. But I also thought about how many moments I've missed before because of my skin. This time, I didn't want eczema to win. So I made a plan. Prepping for big life moments when my skin isn't cooperating starts with adjusting my mindset. I remind myself that I deserve to show up, even if my skin isn't perfectly calm. I talk to myself like I would to a friend, gently but firmly, and I give myself permission to enjoy what's in front of me, even if I don't feel 100%. Then I go into logistics mode. I pack backup moisturizers, barrier creams, and anything I know will bring me comfort. I also bring clothing that makes me feel confident and protected, like soft fabrics, breathable materials, and silhouettes I can move in without friction. For that Brazil trip, I brought my full skin care kit in a carry-on just in case my luggage got lost. I kept an antihistamine on hand and made sure I stayed hydrated during the flight. I also booked accommodations with laundry access so I could control what detergents were used. On the day of big events like weddings, presentations, or reunions, I give myself extra time to get ready. Not to cover anything up, but to make space to move at my own pace. I prep my skin carefully, use a little makeup if it feels good, and choose an outfit that lets me feel free. That trip to Brazil turned out to be beautiful. I didn't hide my skin. I showed up in sleeveless tops, took photos on the beach, and danced through the heat. I had moments of discomfort, yes. But I also had moments of ease, laughter, and connection. And those are what I remember most. Living with a skin condition doesn't mean you have to sit life out. It just means you learn how to show up differently, with extra care, more patience, and a lot of resilience.
WebMD
2 days ago
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Why COVID Spikes in the Summer, and How to Stay Safe
With cases climbing again, you might be wondering why a "winter virus" keeps returning in the heat, and what you should be doing right now to protect yourself. "A couple of months ago, experts were uncertain about a summer wave," said Jodie Guest, PhD, an epidemiologist at Emory University in Atlanta who has tracked COVID since the start of the pandemic. "The low levels of respiratory illness in spring 2025 and stable variant landscape suggested a quiet summer." But three key indicators now have COVID watchdogs sounding the alarm: a new virus strain, increasing wastewater levels, and emergency room visit upticks in parts of the U.S. The CDC now lists the "COVID-19 epidemic trend" as growing or likely growing for more than half of U.S. states. The strongest indicators were seen in Arkansas, Hawaii, Illinois, Iowa, Kentucky, North Carolina, Ohio, Pennsylvania, Texas, and Virginia. Here's what to know about summer COVID, and how to protect yourself – especially if you have a summer vacation or travel coming up. I thought COVID was a big risk during flu season. Did something change? No, COVID has always had two waves, about six months apart – one in the summer and the other at the height of winter "respiratory season," when flu and respiratory syncytial virus (RSV) also rage. The winter wave typically peaks sometime between "December and February, coinciding with colder weather and increased indoor gatherings," said Guest, senior vice chair of the Department of Epidemiology at Emory's Rollins School of Public Health. "Summer waves have occurred sporadically, often driven by new variants or waning immunity." Here's when COVID peaked the past three summers: 2022: Around Aug. 1 2023: Around Sept. 30 2024: Around Aug. 31 This timing has prompted some experts to theorize that summer waves may be linked to people spending more time indoors with air conditioning during the height of summer heat. Why are there two COVID waves, but influenza only spikes once per year? Some scientists point to rapid mutations and waning immunity from past infection or vaccination. "A big chunk of people will get sick in a wave, and they'll have pretty good immunity to that particular variant, and that immunity is enough to sort of stop that wave in its tracks," said Emily Landon, MD, an infectious disease specialist at UChicago Medicine in Illinois. The virus then needs to change enough to evade existing immunity before another cycle starts back up. A second theory suggests there are three distinct groups of people – a summer group, a winter group, and a group that gets infected twice a year. The idea is based on the idea that people vary in how long they're immune after infection, vaccination, or both. Scientists still need more data to know for sure, "but the bottom line is we're certainly seeing a big increase in cases in the summer and a big increase of cases in the winter," Landon said. Is this surge caused by the new variant? Yes, partly. NB.1.8.1 – or Nimbus – has been on the rise in Asia recently, and it now accounts for as many as 43% of new cases in the U.S., up from 24% at the beginning of June, according to CDC data. It's the variant known for a " razor blade" sore throat symptom, although it doesn't appear to cause more severe illness than other versions of the virus, Landon said. This geographic pattern has become pretty set: A rising variant in Asia or Europe typically foreshadows a rise in the U.S., said Sabrina A. Assoumou, MD, MPH, an infectious disease doctor and professor at Boston University Chobanian & Avedisian School of Medicine. Another regional clue: "We have typically seen that the [U.S.] rise in cases starts in the South," said Assoumou. She noted that some of the highest wastewater levels of SARS-CoV-2 (the virus that causes COVID) are in Florida and Alabama right now. "This is often followed by increases in other parts of the nation such as the Northeast." How can I protect myself from summer COVID? Make sure your vaccination is current. If you got a COVID shot last winter, you're probably good, Landon said. But if you're 65 or older, immunocompromised, or have a health condition that puts you at high risk – the CDC website maintains a list of qualifying conditions – ask your health care provider if you need a booster now. People with upcoming travel should consider a booster, too. Landon, who has rheumatoid arthritis and receives treatment that affects her immune system, just got a booster because she's going on vacation soon. "I want the best protection since I know that we're seeing the beginning of a summer spike," she said. Remember that masks are still an effective tool. If you're traveling, wear a mask like an N-95, KN-95, or KF-94, and make it as snug as you can tolerate. Don't just wear it on the plane; wear it while lining up to board, too. It is OK to slip it down to sip a drink or eat a snack while in flight. "I would absolutely recommend that everyone wear a mask on an airplane," Landon said. "The last thing you want is even any kind of cold, let alone COVID, when you're on vacation." Pack some COVID tests in your travel bag. If you know you have COVID, you can consider starting antiviral medication right away, which can reduce your risk of hospitalization. Maybe bring a Paxlovid prescription too. If you're older or have a condition that puts you at high risk, ask your doctor to prescribe Paxlovid or another antiviral called molnupiravir to bring with you in case you get sick. Ask sick people to stay home. If you're planning a summer party, Landon suggested adding a note to the bottom of the invite that says, "We have some high-risk people coming. If you're not feeling well, we'll take a pass and meet up with you another time when you're feeling better." Some people feel obligated to attend parties even when they aren't feeling well. "Letting them know that they're off the hook if they're sick and that you really don't want them to come if they're sick is a really important way that you can help protect your own health and help other people to do the right thing," Landon said.
WebMD
5 days ago
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CVI in the Spotlight: 5 Things Older Adults Should Know
July 18, 2025 – President Donald Trump's recent diagnosis of chronic venous insufficiency (CVI) has sparked renewed interest in the condition – but for millions of Americans, it's already a familiar reality. CVI is a common circulatory issue that affects blood flow from the legs back to the heart, causing blood to pool or collect in the lower legs. Estimates show it impacts about 25 million U.S. adults. Here's what to know about CVI – and how to check your own risk. 1. Mild swelling in the legs can be an early warning sign. Why it matters: Swelling or heaviness in the lower leg and ankle is a common symptom of chronic venous insufficiency, though pain is the most common symptom, according to the American Heart Association. The pain might get worse when you stand or improve when you raise your legs. Other red flags include a dull ache, cramping, tingling, burning, or itching sensation in your legs; varicose veins; or irritated, cracked, discolored, flaky, weepy, or roughened skin. The condition isn't usually life-threatening, but without treatment, the swelling could get worse, leading to ulcers that carry a risk of infection. What you need to know:"Early detection and treatment can make a substantial difference," Joshua A. Beckman, MD, former chair of the American Heart Association's Vascular Health Advisory Committee and Scientific Council on Peripheral Vascular Disease, said in a statement from the American Heart Association. "That is why it is vital for individuals to be aware of the signs and symptoms of CVI so they can seek timely medical evaluation and intervention." Treatments vary, depending on how severe they are. A doctor might start by recommending compression stockings for the swelling, and gentle exercise (walking, water therapy) to improve blood flow. For more advanced stages, damaged veins can be closed using injections, laser treatments, or high-frequency radio wave procedures, and surgery can repair or remove affected veins. 2. CVI is common in older adults. Why it matters: Your risk of chronic venous insufficiency increases as you get older, particularly after age 50. "As people age, the valves in their leg veins, which are responsible for maintaining blood flow towards the heart, can weaken or become damaged," according to the American Heart Association's statement. "This makes it harder for blood to flow back efficiently, allowing backward flow of blood in the veins, leading to blood pooling in the legs and the development of CVI." What you need to know: Other risk factors include obesity, smoking, a history of pregnancy, previous blood clots, or a family history of chronic venous insufficiency. A sedentary lifestyle or prolonged periods of sitting or standing can also raise your risk. 3. Doctors often diagnose CVI using Doppler ultrasound of both legs. Why it matters: Doppler ultrasounds are noninvasive tests that measure sound waves echoing from red blood cells, revealing how blood moves through vessels. During a Doppler ultrasound for chronic venous insufficiency, a doctor places a small device on your skin, covering the affected area, to check how quickly and in what direction the blood flows. What you need to know: This is also how doctors look for signs of deep vein thrombosis or arterial disease. Deep vein thrombosis is a potentially deadly blood clot that starts in the deep veins of the legs and can spread to the lungs. Peripheral artery disease is a common condition, often found in people with diabetes or high cholesterol, that restricts blood flow in the lower legs. While chronic venous insufficiency affects the blood flow from your legs to your heart, peripheral artery disease affects the vessels traveling the other way – carrying blood from your heart to your legs. 4. Blood tests and an echocardiogram can help rule out heart failure, kidney issues, or systemic illness. Why it matters: These blood tests – which included a complete blood count, comprehensive metabolic panel, coagulation profile, D-dimer, B-type natriuretic peptide, and cardiac biomarkers – and imaging tests are commonly used to check for signs of blood clots, heart problems, and kidney problems. What you need to know: Chronic venous insufficiency is linked to an increased risk of deep vein thrombosis and diseases of the heart and blood vessels, which might be partially explained by shared risk factors. Heart health and kidney health are closely related. 5. The diagnosis was shared following public questions about leg swelling and hand bruising. Why it matters: Trump's doctor said the bruises on his hands are a side effect of aspirin, which he takes to help prevent diseases in his heart and blood vessels. What you need to know: Aspirin thins the blood, increasing the risk of bruising. Because aspirin is a blood thinner and inhibits blood clots, some people, especially those at a heightened risk of heart disease, take it to reduce the risk of heart attacks and strokes. But this treatment also comes with the risk of another, potentially more dangerous side effect: bleeding in your gut. Before trying aspirin, or any new medication, talk to your doctor about the risks and benefits based on your health history and risk factors.
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5 days ago
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The Surprising Long-Term Risk of Traveler's Diarrhea
July 18, 2025 – Diarrhea can do much more than ruin your vacation. It sometimes triggers irritable bowel syndrome, a chronic condition that can linger months or even years after you've arrived back home. "It's important for people to know this can happen," said gastroenterologist Xiao Jing Wang, MD, an assistant professor at the Mayo Clinic. "We have a lot of patients whose symptoms don't go away, and they start doing all types of testing. It's worth it to know that sometimes, these infections can have aftereffects that can linger." Nearly 1 in 8 people who get traveler's diarrhea continue to have symptoms for at least six months, one study found. Of those, nearly 80% have symptoms for at least a year. IBS causes belly pain and bloating, as well as diarrhea or constipation – or both. The after-travel condition is called post-infectious IBS (PI-IBS), and it can become a lifelong issue for some. "About 25% to 30% continue to have symptoms after 10 years," said Wang. What Is Post-Infectious IBS? Traveler's diarrhea, which is caused by bacterial, viral, or parasitic infections, essentially falls under the umbrella of food poisoning. You get it from picking up pathogens like campylobacteria and E. coli from poorly sanitized food or water when traveling. Post-infectious IBS is when your symptoms persist after the infection clears. "We now believe that a lot of IBS in this country may have started with an enteric [food poisoning] infection," said Bradley Connor, MD, medical director of the New York Center for Travel and Tropical Medicine in New York City. There are different theories as to how traveler's diarrhea triggers IBS, and experts agree it's likely a combination of things. One theory is that it triggers an autoimmune response due to a mistaken identity of a protein. The bacteria most commonly linked to traveler's diarrhea – shigella, campylobacter, salmonella, and E. coli – release a toxin. This toxin resembles a protein in the intestines, called vinculin, that's important for healthy gut function. The theory is that the immune system can confuse the two molecules. So it produces antibodies to the toxin – but also to vinculin, said Mark Pimentel, MD, executive director of the Medically Associated Science and Technology program at Cedars-Sinai Medical Center in Los Angeles. Disrupting vinculin can lead to poor gut function and an overgrowth of certain bacteria, which contributes to IBS. Pimentel published a study that found 56% of people with IBS tested positive for vinculin antibodies. Traveler's diarrhea can also be caused by parasites, like giardia, which has the highest rate of triggering PI-IBS. But giardia doesn't release the toxin, meaning something else is probably at play. It is likely a disrupted gut microbiome, said Wang. Traveler's diarrhea changes the makeup of good bacteria and bad bacteria in the gut. "We know that there are major distortions in the microbiome when people travel," said Connor. The good bacteria have anti-inflammatory properties and help control how well something can pass from the gut to the bloodstream. If the gut gets overwhelmed by bad bacteria, it can lead to chronic inflammation, changes in how the intestines empty, and ultimately the symptoms of IBS. Risk Factors for Post-Infectious IBS It's not known why some people develop PI-IBS, though certain things can increase your risk. It's more common in women and young people, and some may be more likely to have it because of their genes, said Wang. The risk tends to be higher if you have a severe case of food poisoning. Also, if you already have PI-IBS, you have a higher chance of getting it again or having more severe symptoms. What Can You Do to Reduce Your Risk? The most important thing is to protect yourself from getting traveler's diarrhea. If you're visiting high-risk regions, such as developing countries in Central and South America, Mexico, Africa, the Middle East and Asia, take these precautions: Avoid raw food, including unpasteurized dairy products, and raw or undercooked meat, fish, shellfish, eggs, and produce. Avoid salads, uncooked vegetables, and raw and unpeeled fruit. Avoid food and beverages from street vendors. Avoid tap water and ice unless it's known to be safe, and use bottled water instead. Taking bismuth subsalicylate (Pepto-Bismol) preventively has been shown to reduce the risk of getting traveler's diarrhea. But the recommended dose is two tablets four times a day, which is inconvenient, said Connor. For people with a higher risk, such as those with PI-IBS or inflammatory bowel disease, doctors may prescribe an antibiotic called rifaximin preventively if they're travelling to high-risk regions. Rifaximin is poorly absorbed, so it doesn't negatively affect the gut biome. It's approved to treat traveler's diarrhea but used preventively off-label (meaning doctors prescribe it to help prevent diarrhea, even though it's not FDA approved for that use). Lastly, if you get food poisoning, avoid taking antibiotics for mild traveler's diarrhea. Antibiotics can make symptoms worse because they disrupt the microbiome even more. More severe cases caused by certain bacteria may need antibiotics. "It's OK to use them if your doctor says you need it," said Wang.
