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MelanieBoneMD
(Physician
- OBGYN - Obstetrics-Gynecology
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| Communities: Urinary and Bladder Cancer | Thank You's: 7 |
| Member Since: Jan. 2012 | Questions: 0 |
| Answers: 10 |
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Professional Statement
Dr. Bone is board certified in Obstetrics & Gynecology by the American Board of Obstetrics and Gynecology. She received her medical degree from Albany Medical College and completed a residency at George Washington University Hospital. She now resides in South Florida with her husband and four children.
Dr. Bone is a national speaker on hereditary cancer syndromes and writes a column for the Palm Beach Post Health. She actively practices gynecologic surgery with expertise in minimally-invasive laparoscopic surgery, menopause, cancer risk assessment, solutions and support.
Dr. Bone prides herself on combining a down-to-earth bedside manner with cutting-edge clinical skills. She believes that listening well to your patients is the key to making a diagnosis and best outcomes are obtained by applying a common-sense approach to each woman’s problem. Dr. Bone embraces integrative medicine, often using both traditional and non-traditional solutions to gynecologic issues. She is affable, available, approachable, and able – the 4 “A”s of an excellent doctor.
Dr. Bone is a national speaker on hereditary cancer syndromes and writes a column for the Palm Beach Post Health. She actively practices gynecologic surgery with expertise in minimally-invasive laparoscopic surgery, menopause, cancer risk assessment, solutions and support.
Dr. Bone prides herself on combining a down-to-earth bedside manner with cutting-edge clinical skills. She believes that listening well to your patients is the key to making a diagnosis and best outcomes are obtained by applying a common-sense approach to each woman’s problem. Dr. Bone embraces integrative medicine, often using both traditional and non-traditional solutions to gynecologic issues. She is affable, available, approachable, and able – the 4 “A”s of an excellent doctor.
Professional Info
Credential:
MD
Primary specialty:
OBGYN - Obstetrics-Gynecology
Medical school:
Albany Medical College
Residency:
George Washington University Hospital
Board certifications:
American Board of Obstetrics and Gynecology
Awards and publications:
March of Dimes Woman of the Year
American Committee for the Weizmann Institute of Science Woman of Vision
Board Member Emeritus – Breastcancer.org
American Committee for the Weizmann Institute of Science Woman of Vision
Board Member Emeritus – Breastcancer.org
Hospital affiliation:
JFK Medical Center
Practice name:
Women's Health and Healing of the Palm Beaches
Practice address:
5301 S. Congress Ave Suite 400 Rothman Center
Atlantis, FL
33462
Practice phone number:
(561) 548-8600
Twitter
http://twitter.com/AskDrBone
Personal Bio (My story)
Following Stage III cancer, a double mastectomy, chemotherapy and radiation therapy, I committed myself to help prevent women from getting breast cancer and help every survivor live longer.
MelanieBoneMD Activities
My index of suspicion would be high and my threshold to remove the ovaries would be low. Hope that helps.
MelanieBoneMD (Physician - OBGYN - Obstetrics-Gynecology (Verified)) replied to answer by member1665 (Survivor (2 - 5 years))
2
Answers |
3 months ago
In patients with the BRCA gene, ovarian cancer can occur in addition to breast cancer. The risk depends on which BRCA gene mutation they inherited, with BRCA 1 patients having a risk of ovarian cancer as high as 44% and BRCA 2 patients having a risk as high as 27%. For patients without the BRCA gene, the risk is much lower. Breast cancer can metastasize to the ovary, causing tumors called Krukenberg tumors. Years ago, before the advent of medications to suppress estrogen formation by the ovary, many oncologists requested that the ovaries be removed to reduce estrogen in premenopausal breast cancer patients. That is not really done anymore except in extenuating circumstances. At the moment, there is no specific protocol to monitor the ovaries of breast cancer survivors. Some gynecologists will not change their standard care and others will offer sonograms (ultrasounds) both to assess the uterine lining in patients taking Tamoxifen and to look at the ovaries. Sadly, as mentioned in other questions on this site, ovarian cancer can be sneaky and not show up on scans. My thought is to not worry too much unless you are BRCA positive. Please ask your doctor if you qualify for testing.
In patients with the BRCA gene, ovarian cancer can occur in addition to breast cancer. The risk depends on which BRCA gene mutation they inherited, with BRCA 1 patients having a risk of ovarian cancer as high as 44% and BRCA 2 patients having a risk as high as 27%. For patients without the BRCA gene, the risk is much lower. Breast cancer can metastasize to the ovary, causing tumors called Krukenberg tumors. Years ago, before the advent of medications to suppress estrogen formation by the ovary, many oncologists requested that the ovaries be removed to reduce estrogen in premenopausal breast cancer patients. That is not really done anymore except in extenuating circumstances. At the moment, there is no specific protocol to monitor the ovaries of breast cancer survivors. Some gynecologists will not change their standard care and others will offer sonograms (ultrasounds) both to assess the uterine lining in patients taking Tamoxifen and to look at the ovaries. Sadly, as mentioned in other questions on this site, ovarian cancer can be sneaky and not show up on scans. My thought is to not worry too much unless you are BRCA positive. Please ask your doctor if you qualify for testing.
New answer by MelanieBoneMD (Physician - OBGYN - Obstetrics-Gynecology (Verified)) in topic(s) Ovarian Cancer Risk Factors, Breast Cancer, Cancer Screening, Ovarian Cancer Risk, Ovarian Cancer Screening, Ovarian Cancer
1
Answer |
3 months ago
Most uterine malformations are just bad luck. Daughters of women who took DES when they were pregnant are at higher risk of uterine and cervical problems. Smoking in and of itself is associated with a higher risk of cervix cancer. Virtually all cervical cancer is caused by the HPV virus, which is a sexually transmitted infection. Women who smoke and are exposed to HPV may be at increased risk of developing precancerous changes on their pap smear and need to see their gynecologist yearly.
Most uterine malformations are just bad luck. Daughters of women who took DES when they were pregnant are at higher risk of uterine and cervical problems. Smoking in and of itself is associated with a higher risk of cervix cancer. Virtually all cervical cancer is caused by the HPV virus, which is a sexually transmitted infection. Women who smoke and are exposed to HPV may be at increased risk of developing precancerous changes on their pap smear and need to see their gynecologist yearly.
New answer by MelanieBoneMD (Physician - OBGYN - Obstetrics-Gynecology (Verified)) in topic(s) Gynecologic Cancer Risk Factors, Smoking, Cervical Cancer, Cancer Risk Factors, Gynecologic Cancers, Gynecological Deformity, Pregnancy, Ovarian Cancer
1
Answer |
3 months ago
Great question. Not many. Most ovarian cancer just happens because of bad luck. Less than 25% of ovarian cancer is caused by an inherited identifiable genetic mutation. Certainly a patient with a family history of ovarian cancer should be evaluated to determine if she qualifies for BRCA testing. This can be done either by a formally-trained genetic counselor or by less-formally-trained healthcare providers who have been educated about risk assessment for various cancers including ovarian cancer. Ovarian cancer happens to about 1% of women with no risk factors. If a first degree relative has ovarian cancer, the risk goes up to 4%. If the patient has a BRCA mutation, the risk can be as high as 44%. With Lynch syndrome, a combination of uterine, colon, ovarian, and a few other cancers, the risk is between 10-15%. Women who have never had a baby, who had early menarche and late menopause, and who have never taken the pill are at slightly higher risk given that there ovaries never took a break from ovulating. There is controversy over whether "super ovulation" (using medications to increase the number of eggs ovulated) used in infertility patients increases the risk of ovarian cancer. Patients with any of these factors are evaluated regularly and advised to report any changes in bowel or bladder habits or pelvic symptoms that might be associated with ovarian cancer (see prior question).
Great question. Not many. Most ovarian cancer just happens because of bad luck. Less than 25% of ovarian cancer is caused by an inherited identifiable genetic mutation. Certainly a patient with a family history of ovarian cancer should be evaluated to determine if she qualifies for BRCA testing. This can be done either by a formally-trained genetic counselor or by less-formally-trained healthcare providers who have been educated about risk assessment for various cancers including ovarian cancer. Ovarian cancer happens to about 1% of women with no risk factors. If a first degree relative has ovarian cancer, the risk goes up to 4%. If the patient has a BRCA mutation, the risk can be as high as 44%. With Lynch syndrome, a combination of uterine, colon, ovarian, and a few other cancers, the risk is between 10-15%. Women who have never had a baby, who had early menarche and late menopause, and who have never taken the pill are at slightly higher risk given that there ovaries never took a break from ovulating. There is controversy over whether "super ovulation" (using medications to increase the number of eggs ovulated) used in infertility patients increases the risk of ovarian cancer. Patients with any of these factors are evaluated regularly and advised to report any changes in bowel or bladder habits or pelvic symptoms that might be associated with ovarian cancer (see prior question).
New answer by MelanieBoneMD (Physician - OBGYN - Obstetrics-Gynecology (Verified)) in topic(s) Ovarian Cancer Risk Assessment, Cancer Risk, Cancer Risk Assessment, Ovarian Cancer Risk, Cancer Risk Models, Ovarian Cancer, Cancer Risk Tools
1
Answer |
3 months ago
Unfortunately there is no easy and reliable way to diagnose ovarian cancer early. When the cancer is far enough along to start causing symptoms of pelvic pressure, urinary frequency, feeling full after eating small quantities of food, and tummy enlargement from fluid in the abdomen and pelvis, it is almost always at least Stage lll and easily seen with a sonogram or CAT scan or MRI. The symptoms of early ovarian cancer are subtle and often misconstrued as bowel problems. They are sometimes called the ovarian cancer "whisper" because they aren't easily heard. Burping or excess flatulence more than half the time, should prompt a visit to be checked. Most gynecologists will perform a pelvic exam. I would suggest a transvaginal sonogram (TVU) to look for cysts and fluid. If there is fluid in the pelvis that can be sampled with a needle, the diagnosis can be made from finding ovarian cancer cells in the fluid. Usually the TVU is diagnostic at that point anyway and sampling the fluid is just confirming the diagnosis. Sadly, the TVU may not show anything worrisome in the earliest stages of ovarian cancer. Often patients with and without symptoms ask for a CA 125 blood test or the newer OVA1 test to look for cancer. These tests are not good for screening because of the high false positive rate. In my experience they often come back high when there is no obvious abnormality. Then what? The patient undergoes surgery because they get nervous. Hopefully the answer to the dilemma of diagnosing ovarian cancer is right around corner.
Unfortunately there is no easy and reliable way to diagnose ovarian cancer early. When the cancer is far enough along to start causing symptoms of pelvic pressure, urinary frequency, feeling full after eating small quantities of food, and tummy enlargement from fluid in the abdomen and pelvis, it is almost always at least Stage lll and easily seen with a sonogram or CAT scan or MRI. The symptoms of early ovarian cancer are subtle and often misconstrued as bowel problems. They are sometimes called the ovarian cancer "whisper" because they aren't easily heard. Burping or excess flatulence more than half the time, should prompt a visit to be checked. Most gynecologists will perform a pelvic exam. I would suggest a transvaginal sonogram (TVU) to look for cysts and fluid. If there is fluid in the pelvis that can be sampled with a needle, the diagnosis can be made from finding ovarian cancer cells in the fluid. Usually the TVU is diagnostic at that point anyway and sampling the fluid is just confirming the diagnosis. Sadly, the TVU may not show anything worrisome in the earliest stages of ovarian cancer. Often patients with and without symptoms ask for a CA 125 blood test or the newer OVA1 test to look for cancer. These tests are not good for screening because of the high false positive rate. In my experience they often come back high when there is no obvious abnormality. Then what? The patient undergoes surgery because they get nervous. Hopefully the answer to the dilemma of diagnosing ovarian cancer is right around corner.
New answer by MelanieBoneMD (Physician - OBGYN - Obstetrics-Gynecology (Verified)) in topic(s) Ovarian Cancer Tests, Cancer Diagnosis, Ovarian Cancer Symptoms, Ovarian Cancer Diagnosis, Diagnosis, Ovarian Cancer
1
Answer |
3 months ago
One of my patients was diagnosed with breast cancer when undergoing in vitro fertilization. She went through menopause and never got a period until over a year later when she didn't really feel well and was 3 months pregnant without any help! That child is now in school and doing fine - a true gift from god. Yes, many women come out of chemo pause. Some in a few months and others longer. There is no real way to predict except to say that the closer a patient is to menopause when starting chemotherapy, the less likely she will be to come out of chemo pause.
One of my patients was diagnosed with breast cancer when undergoing in vitro fertilization. She went through menopause and never got a period until over a year later when she didn't really feel well and was 3 months pregnant without any help! That child is now in school and doing fine - a true gift from god. Yes, many women come out of chemo pause. Some in a few months and others longer. There is no real way to predict except to say that the closer a patient is to menopause when starting chemotherapy, the less likely she will be to come out of chemo pause.
New answer by MelanieBoneMD (Physician - OBGYN - Obstetrics-Gynecology (Verified)) in topic(s) Chemotherapy Side Effects, Menopause, Side Effects, Cancer, Chemo-induced Menopause
2
Answers |
3 months ago
NO, NO, NO. Just today I met with two pediatricians. We were discussing the BRCA gene. I explained that young girls with BRCA should go on oral contraceptives to keep their ovaries calm until they want to get pregnant as the pill decreases ovarian cancer. They looked at me skeptically. There have only been a few studies relating pills and breast cancer and the association was seen in women who never had children and took the pill for decades. There were confounding data that made it impossible to implicate the pill itself. I am a fan of the pill and think it does amazing things including preventing uterine and ovarian cancer, anemia, and missed school because of cramps. And it is far safer to prevent an unwanted pregnancy than to have an abortion or carry a full term pregnancy.
The day I was diagnosed with breast cancer my doctors told me I had to stop taking the pill. When I asked why they told me becasue, "they can cause breast cancer". I went straight home and opened up the pill pack pamphlet folded up in the lid, the one I never read for 15 years, and it says it right there in black and white. I firmly believe that the Rx manufacturers are required to disclose this for a reason and I bet if you talked to enough breast cancer survivors you would learn that this is a huge common denominator. I don't believe it is any coincidence. Dr. Malcolm Pike, epidemiologist at SLoan Kettering Cancer Institute has said he believes the risk increase is closer to 21%, not the "claimed 2%"
New answer by MelanieBoneMD (Physician - OBGYN - Obstetrics-Gynecology (Verified)) in topic(s) Birth Control Medications, Cancer Risk, Birth Control, HRT (Hormone Replacement Therapy), Breast Cancer Risk Factors, Birth Control Pills, Cancer Risk Factors, Breast Cancer Risk
2
Answers |
3 months ago
The HALO test is based on data that showed that women with nipple discharge had a higher risk of breast cancer over the course of their lives. A machine that looks and acts a lot like a breast pump massages the breast and uses a vacuum-like action to seek fluid. Unfortunately, a large number of women will have nipple fluid in this circumstance, some say as high as 50%. Trying to figure out what to do with them afterward is a challenge. Data have shown that send nipple aspirated fluid for cytologic evaluation is not particularly helpful in figuring out who is at risk, nor does it diagnose or rule out cancer definitively. I have found that it makes women more anxious. The theory is that these women will be followed more closely, but that is a double-edged sword. They undergo more testing and probably more biopsies, but ultimately I have not seen data proving that more lives are saved.
As for BREVAGEN, it is a model based on combining the Gail Model (a risk assessment tool that is known to be inaccurate for many reasons) with a mouth swab looking for 7 single nucleotide polymorphisms (SNPs) which can modify the Gail risk upward or downward. In the fine print of the test, it acknowledges that it works best in Caucasians over the age of 35. It doesn't take into account breast cancer in the father's side, second- and third-degree relatives with cancer, nor does it consider other related cancers as risk factors. The idea is an interesting one, but needs to be developed further.
The HALO test is based on data that showed that women with nipple discharge had a higher risk of breast cancer over the course of their lives. A machine that looks and acts a lot like a breast pump massages the breast and uses a vacuum-like action to seek fluid. Unfortunately, a large number of women will have nipple fluid in this circumstance, some say as high as 50%. Trying to figure out what to do with them afterward is a challenge. Data have shown that send nipple aspirated fluid for cytologic evaluation is not particularly helpful in figuring out who is at risk, nor does it diagnose or rule out cancer definitively. I have found that it makes women more anxious. The theory is that these women will be followed more closely, but that is a double-edged sword. They undergo more testing and probably more biopsies, but ultimately I have not seen data proving that more lives are saved.
As for BREVAGEN, it is a model based on combining the Gail Model (a risk assessment tool that is known to be inaccurate for many reasons) with a mouth swab looking for 7 single nucleotide polymorphisms (SNPs) which can modify the Gail risk upward or downward. In the fine print of the test, it acknowledges that it works best in Caucasians over the age of 35. It doesn't take into account breast cancer in the father's side, second- and third-degree relatives with cancer, nor does it consider other related cancers as risk factors. The idea is an interesting one, but needs to be developed further.
As for BREVAGEN, it is a model based on combining the Gail Model (a risk assessment tool that is known to be inaccurate for many reasons) with a mouth swab looking for 7 single nucleotide polymorphisms (SNPs) which can modify the Gail risk upward or downward. In the fine print of the test, it acknowledges that it works best in Caucasians over the age of 35. It doesn't take into account breast cancer in the father's side, second- and third-degree relatives with cancer, nor does it consider other related cancers as risk factors. The idea is an interesting one, but needs to be developed further.
The HALO test is based on data that showed that women with nipple discharge had a higher risk of breast cancer over the course of their lives. A machine that looks and acts a lot like a breast pump massages the breast and uses a vacuum-like action to seek fluid. Unfortunately, a large number of women will have nipple fluid in this circumstance, some say as high as 50%. Trying to figure out what to do with them afterward is a challenge. Data have shown that send nipple aspirated fluid for cytologic evaluation is not particularly helpful in figuring out who is at risk, nor does it diagnose or rule out cancer definitively. I have found that it makes women more anxious. The theory is that these women will be followed more closely, but that is a double-edged sword. They undergo more testing and probably more biopsies, but ultimately I have not seen data proving that more lives are saved.
As for BREVAGEN, it is a model based on combining the Gail Model (a risk assessment tool that is known to be inaccurate for many reasons) with a mouth swab looking for 7 single nucleotide polymorphisms (SNPs) which can modify the Gail risk upward or downward. In the fine print of the test, it acknowledges that it works best in Caucasians over the age of 35. It doesn't take into account breast cancer in the father's side, second- and third-degree relatives with cancer, nor does it consider other related cancers as risk factors. The idea is an interesting one, but needs to be developed further.
New answer by MelanieBoneMD (Physician - OBGYN - Obstetrics-Gynecology (Verified)) in topic(s) HALO, Breast Cancer Tests, Breast Cancer Screening, Cancer Screening Tests, Breast Cancer Screening Tests, Cancer Screening, BREVAGen Test, HALO Test
2
Answers |
3 months ago
Hard question to answer. In addition to BRCA, did anybody undergo BART testing? This test is for large DNA rearrangements and is done through Myriad Genetics. If it has been done, then your family falls in a high-risk familial breast cancer category. I would treat y daughter's breasts as if there were a BRCA mutation in the family and offer annual MRI alternating with mammogram and sonogram every 6 months. In between I would suggest that she have clinical breast exams, one by her gynecologist and one by a breast surgeon. If she is exceedingly anxious or is hard to examine, I would consider prophylactic mastectomies with immediate reconstruction. It cannot totally eliminate the risk of cancer, but brings it down to less than that of the general public. The reason risk still exists is that a minute amount of breast tissue remains after a mastectomy and could still result in a breast cancer, but there is nothing better available at this time.
Hi AnneMarie,
I would suggest that you call your genetic counselor. The genetic counselor knows your history & can advise you best..That's just MY OPINION!
xoxo Tobey
I would suggest that you call your genetic counselor. The genetic counselor knows your history & can advise you best..That's just MY OPINION!
xoxo Tobey
New answer by MelanieBoneMD (Physician - OBGYN - Obstetrics-Gynecology (Verified)) in topic(s) Cancer Risk, Breast Cancer High Risk, Breast Cancer Risk
2
Answers |
3 months ago
Another great question. It depends on the patient and her level of anxiety. Years ago I was uniformly aggressive in my recommendations. Having survived Stage lll breast cancer myself, I was fully in favor of bilateral mastectomies. As I have aged and met more patients I will share with you that my attitude is a little different. If the patient is not ready to have both her breasts removed then she should not be pressured to have mastectomies. With a combination of breast exams by professionals, MRIs, mammograms and sonograms, these patients can be followed closely until one of two things happens: the patient develops cancer and then the decision is not so much elective as therapeutic, or, if she cannot tolerate the stress of the vigilance and then is ready to undergo more definitive surgery to prevent cancer. In my 20+ year career as a physician, I have rarely met a patient who regretted having bilateral mastectomies, but many who regretted not doing so. As for the ovaries, I remain aggressive. If the patient has a high risk of cancer, I explain that vigilance is far from perfect and the hormonal function of the ovaries can be replaced a number of ways, but ovarian cancer is very difficult to cure.
Another great question. It depends on the patient and her level of anxiety. Years ago I was uniformly aggressive in my recommendations. Having survived Stage lll breast cancer myself, I was fully in favor of bilateral mastectomies. As I have aged and met more patients I will share with you that my attitude is a little different. If the patient is not ready to have both her breasts removed then she should not be pressured to have mastectomies. With a combination of breast exams by professionals, MRIs, mammograms and sonograms, these patients can be followed closely until one of two things happens: the patient develops cancer and then the decision is not so much elective as therapeutic, or, if she cannot tolerate the stress of the vigilance and then is ready to undergo more definitive surgery to prevent cancer. In my 20+ year career as a physician, I have rarely met a patient who regretted having bilateral mastectomies, but many who regretted not doing so. As for the ovaries, I remain aggressive. If the patient has a high risk of cancer, I explain that vigilance is far from perfect and the hormonal function of the ovaries can be replaced a number of ways, but ovarian cancer is very difficult to cure.
New answer by MelanieBoneMD (Physician - OBGYN - Obstetrics-Gynecology (Verified)) in topic(s) Breast Cancer, Breast Cancer High Risk, Ovarian Cancer High Risk, Ovarian Cancer
1
Answer |
3 months ago
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