Entries for August 2008

People, it's said, fear public speaking more than they fear death. But if that adage applied to Michelle Obama when she took the podium last night, before a crowd of about 20,000 and a TV viewing audience of millions, it was hardly noticeable. To me, she seemed a little stiff when she first started speaking to the Democratic National Convention but then quickly got into her groove, embracing the crowd. I got the sense that she was actually in her element, happy to be there.

How did this woman, who's not a politician and is relatively new to the campaign scene, do that? I must admit I was a little envious. On those few occasions when I've given speeches, I've tended to get distracted worrying about boring those who are listening to me. I even get a little tense before speaking in a conference room filled with friendly colleagues. And for some people, public speaking generates so much anxiety that doctors consider it a mental health disorder. What exactly does it take to get over one's fears and master the art of public speaking? I did a little digging, and gleaned these five tips.

As the mother of 12-year-old girl, I was disturbed when I read this recent Today Show blog on the growing popularity of professional hair waxing for preteens; one mother actually booked a bikini wax for her 8-year-old! I'm not sure whether it's the moms or the girls themselves who are pushing the must-grow-up-before-puberty trend. This is highlighted in a new documentary called America the Beautiful, which investigates the overemphasis on supermodel good looks in this country. I'm also troubled, though, by something else: the growing acceptance of antiaging plastic surgery in women over 30 who never want to see a wrinkle or frown line creep onto their faces.

What prompted my concern is a series of articles from the August issue of Vogue focusing on trouble spots that need addressing as we age, like armpit bulges, widening nostrils, and sagging knees. I actually grabbed the issue—while getting a pedicure—for its compelling cover line: "The Age (Less) Issue: Vogue's Guide to Looking Amazing at Every Decade." Who can't use a little of that? And I was impressed with the splashy photo profiles of John McCain's 95-year-old mother, who stumps for him on the campaign trail, and actress/UNICEF ambassador Mia Farrow, who, I learned, cuts her own hair and nails because she doesn't want to waste time in salons.

When I blogged yesterday about Christina Applegate's revelation that she carried a breast cancer gene mutation, I didn't realize she was one of the lucky ones. Not in the sense that the actress inherited the BRCA-1 mutation, which greatly increased her odds of breast cancer, but because her doctor recognized early on that she was at increased risk because of her mother's history of the disease. She started having mammograms at age 30 and then switched to high-tech magnetic resonance imaging after having a biopsy last year that turned out to be benign. Applegate told ABC's Good Morning America that she credits her doctor's insistence that she get an MRI with saving her life because it caught the cancer at its earliest stage, before it spread into the surrounding breast tissue or lymph nodes.

Many women aren't as lucky. One reader E-mailed me yesterday that her doctor never flagged her as being at high risk even though she had an extensive family history of breast and ovarian cancer. She wasn't offered additional screening and didn't find out she carried a breast cancer gene mutation until after she was diagnosed with a moderate-size tumor. She wrote that she would have had a prophylactic double mastectomy years earlier had she known she carried the gene. (When Applegate learned, after her diagnosis, that she had the gene, she also opted to get both breasts removed.)

Recently diagnosed with breast cancer, actress Christina Applegate hit the airwaves this morning looking beautiful, adding a new face to the mosaic of breast cancer patients that we see in our daily lives. Perhaps even when we look in the mirror ourselves. (You can watch her interview on ABC's Good Morning America here.) The 36-year-old bravely revealed that she had a double mastectomy three weeks ago to get rid of the tumor in one breast and to prevent future tumors in the other. (She had tested positive for the BRCA-1 breast cancer gene mutation and thus found out she had an 87 percent likelihood.)

I'm guessing her mother passed on the gene, since she also had breast cancer years earlier. Men, too, can pass on the gene—and can even inherit it, as my colleague Adam Voiland reported last year, putting them at higher risk of breast cancer. Applegate and other female gene carriers also have a 44 percent chance of developing ovarian cancer.Television writer Jessica Queller recently wrote about facing the devastating decision of whether to have her ovaries removed as well as her breasts, since doing so slashes cancer risk by more than 90 percent. Applegate revealed that she's planning to have breast reconstruction several months down the road, lightheartedly predicting that "I'm gonna have cute boobs till I'm 90."

If you're an adult woman, have never had an abortion, and suddenly find yourself pregnant unexpectedly, will you put yourself at risk for depression if you choose to terminate the pregnancy? The American Psychological Association says no, based on a new review of the literature presented at their annual conference this week. While women who have abortions may experience feelings of grief and loss, they aren't at any greater risk of developing mental health problems like stress, depression, and anxiety over the long haul. The APA report disputes previous findings showing that such a link does exist. "These studies, for the most part, were seriously flawed," says psychologist Brenda Major, who headed the task force that issued the report. She says they didn't take into account such things as poverty, history of emotional problems, or previous drug use, all of which increase a woman's odds of developing depression or anxiety.

I've no doubt that antiabortion groups will be sending out their own missives to dispute the findings of this review. That's because the findings apply only to a specific subgroup of those getting abortions: adult women with unplanned pregnancies, choosing to have a single abortion during the first 12 weeks of pregnancy. "The evidence is less clear" for teenagers, women who have multiple abortions, and those who have abortions later in pregnancy, admits Major. The report concedes: "A teenager who terminates her first pregnancy, for example, may experience different psychological effects compared to an adult woman who terminates a pregnancy after giving birth to several children."

As I scanned my E-mails this morning, several were from readers asking for my take on the latest breast cancer news showing that the risk of relapse after five years is much lower than a patient might expect. The study, published yesterday in the Journal of the National Cancer Institute, found that once patients make it to the five-year mark without a relapse, about 89 percent are disease free five years later at the 10-year mark and 80 percent at the 15-year mark. That's certainly reassuring news for those patients paralyzed by a fear of relapse long after they finish their treatments.

Still, the statistics quoted in the news reports are meaningless for the individual woman diagnosed with breast cancer. Certainly, cancer can recur 15 years after treatment—or even 20 or 30 years out. One survivor wrote me: "All my doctors informed me that the two-year mark is important and then the six-year mark, but with breast cancer, you are never out of the woods." Today's conflicting news reports could only have added to her confusion. "Risk of Breast Cancer Relapse Can Linger" blares one headline. "Risk of Breast Cancer Relapse Is Low After Surviving 5 Years" declares another.

I can't say I'm too surprised by a new study showing that certain low-tech fertility treatments don't work for women with unexplained infertility. Much is still unknown about what it takes to achieve a successful pregnancy; in fact, for one third of couples who can't get pregnant after a year of trying, there's no apparent medical explanation. The new study, published in the British Medical Journal, randomly assigned some women with unexplained infertility to take the ovulation-stimulating drug clomiphene citrate (Clomid) and others to undergo artificial insemination. A third group of such women just went for regular doctor visits. In the end, all three groups had the same likelihood of giving birth to a child.

What's shocking, though, is how common it is for infertile women to be given treatments that haven't been rigorously tested for effectiveness. "As a direct result of lack of evidence, many couples with unexplained infertility endure [and even request] expensive, potentially hazardous, and often unnecessary treatments," reproductive medicine specialists Tarek El-Toukhy and Yacoub Khalaf write in an editorial that appears in BMJ. Clomid, for example, increases the risk of twins and triplets and could potentially increase the risk of ovarian cancer in those who take it for several months.

Two months ago, I posted a blog about why women lie, and, boy, did I get some heated comments (like this one)! Some readers accused me of being less than honest, and others questioned my contention that women and men lie for different reasons. I responded with my own comment questioning whether we will ever get to the real truth about lying. Well, the website BettyConfidential.com tried to do just that by asking its female members to fill out a survey on lying. The results were released today. Only 33 women completed the survey, so I'd hardly call it a scientific snapshot. Still, the list of questions was pretty comprehensive, and I was surprised at some of the things these women were admitting, such as:

• One third find it "perfectly acceptable" to lie to strangers, though they lie most frequently to coworkers.

• More than half of the respondents said they don't feel that withholding information is a lie.

Yesterday I discussed Christina Applegate's diagnosis of breast cancer, and hundreds of reports on that news have been teeming with information—from the way she was diagnosed to what she can expect from treatment. But nowhere in this burst of coverage have I seen information on a side effect that's rarely talked about: how tough it is for breast cancer patients to maintain an active sex life.

I talked to breast cancer survivor Lisa Martinez about this and how she prepared herself in advance for the sexual difficulties that often follow a disfiguring mastectomy, fatiguing chemotherapy, and drugs that shut off sex hormones like estrogen. Martinez's job as executive director of the Women's Sexual Health Foundation gave her a leg up that many women don't have. "I was fortunate in that I felt comfortable talking about it with my doctors and my husband," the 53-year-old says, "but many women can't. They push it down and bury it, never to reclaim their sexuality again. It's very sad."

When I first heard that actress Christina Applegate had breast cancer, I wondered how the 36-year-old's tumor was detected. Did she find the lump herself, or did her doctor feel it during a regular checkup? Perhaps Applegate was diagnosed via a screening mammogram, like my 37-year-old friend, Panina. Turns out, Applegate's tumor was detected through magnetic resonance imaging, which was ordered by her doctor, according to her publicist. That decision could prove lifesaving because the cancer was caught early—when it's most likely to be cured.

The exquisitely sensitive MRI is very good at detecting tumors in young women whose dense breast tissue often hides tumors on mammogram X-rays. But it's very expensive and all-too-frequently detects false abnormalities that necessitate biopsies. For this reason, the test is recommended only for those at increased risk of breast cancer. (Breast cancer is very uncommon in those under 50, so it would be foolhardy to screen all women in their 30s.) News reports disclosed that Applegate's mother had previously battled breast cancer, but that by itself isn't usually enough to justify an MRI in a woman so young. Last year, the American Cancer Society issued recommendations for the use of MRI screening for women at increased risk of breast cancer, as my colleague Katherine Hobson previously reported. You should have an annual test if you fall into one of these categories: