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Counter-Intuitive Results: Several Cancer Screening Tests Don’t Improve Health Outcomes

Nearly forty years ago, President Richard Nixon famously declared a “War on Cancer” by signing the National Cancer Act of 1971. Like the Manhattan Project, the Apollo program that was then landing men on the Moon, and the ongoing (and eventually successful) World Health Organization-led initiative to eradicate smallpox from the face of the Earth, the “War on Cancer” was envisioned as a massive, all-out research and treatment effort. We would bomb cancer into submission with powerful regimens of chemotherapy, experts promised, or, failing that, we would invest in early detection of cancers so that they could be more easily cured at earlier stages.

It was in the spirit of the latter that the National Cancer Institute launched the Prostate, Lung, Colorectal, and Ovarian Cancer (PLCO) Screening trial in 1992. This massive study, which eventually enrolled more than 150,000 men and women between age 55 and 74, was designed to test the widespread belief that screening and early detection of the most common cancers could improve morbidity and mortality in the long term. Not a few influential voices suggested that the many millions of dollars invested in running the trial might be better spent on programs to increase the use of these obviously-effective tests in clinical practice.

They were wrong. As of now, the PLCO study is 0-for-2. Read more »

*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*

Helpful Breast Cancer Q&A

Preya Ananthakrishnan, MD

Attendees of the breast cancer awareness symposium “Bridging the Gap: Promoting Breast Cancer Prevention, Screening and Wellness” were given the chance to submit questions on breast cancer in the minority community. This is the first part of these questions answered by Dr. Preya Ananthakrishnan, Assistant Professor of Clinical Surgery and a host of the event.

Q: I am a 51 year old Black women, whose mother died 13 years ago from breast cancer & her sister was diagnosed last year. I had a mammography 2 weeks ago and got the dreaded come back letter. Should I get genetic counseling?

Dr. Ananthakrishnan: I would suggest that your sister with the breast cancer get tested first, and if her test result is positive then you should get tested. Furthermore, it is likely that even though you got a “call back” letter after your mammogram, it is very possible that you don’t actually have a breast cancer. I would advise you to go in as soon as possible to work up whatever abnormality was seen. If you do in fact have a breast cancer, then you should certainly undergo genetic testing yourself.

Q: What is considered “early detection” of breast cancer?

Dr. Ananthakrishnan: Early detection is finding a breast cancer before symptoms actually occur. This could be by finding it on a mammogram before actually feeling a lump in the breast, or by finding a small lump before it becomes a big lump. Early detection can sometimes allow for less aggressive treatments and improved outcomes.

Q: Is radical mastectomy surgery still performed? I hear little about it now. Read more »

*This blog post was originally published at Columbia University Department of Surgery Blog*

A Bagels And Boobs Mammogram Party

I don’t always practice what I preach. Regular mammograms, for instance. Last year I realized I had skipped a few, so I decided to turn my procrastination into an opportunity to reach out to those of my patients guilty of the same thing.

I made arrangements with my hospital to monopolize half their schedule one Saturday morning, put flyers up in my office and talked it up like crazy to every eligible woman I saw. On the appointed day, I brought a whole bunch of bagels, half a dozen spreads (I asked the ladies to bring their own coffee), and we proceeded to have a blast! Or as much fun as you can have getting your boobs squished. Hey; it’s all in the name of early detection.

Last year’s final tally was a bakers dozen (twelve patients plus me), out of which about 5 people were called back for more views (mainly those with old films not readily available from other institutions), 2 benign biopsies were done, and one case of invasive breast cancer was diagnosed and treated. Not bad, I thought. Read more »

*This blog post was originally published at Musings of a Dinosaur*

Woman Claims She Found A Simple Way To Kill Cancerous Tumors, Jury Not Convinced

I hope @oracknows, Respectful Insolence, will write more about this. He is much better than I at sussing out fraudulent medical treatments.

I have lived and practiced in Little Rock, AR for over twenty years and I did not know this was in my backyard until my local paper (Arkansas Democrat-Gazette) reported on the outcome of the trial last week. The article title caught my eye as I was skimming the news: Jurors: Cancer therapy a fraud, Award in suit is $2.5 million (subscription only unfortunately).

A federal jury awarded $2.5 million in damages Tuesday to a California woman who paid $6,250 to undergo alternative treatments from a Jacksonville woman who promised a “100 percent success rate” in destroying cancerous breast tumors.

Antonella Carpenter, the former Jacksonville woman who has since moved to Broken Arrow, Okla., and continues to proclaim on her website that she has found a simple, painless way to kill cancerous tumors, wasn’t present for the verdict against her and her company, Lase Med Inc. …….

I don’t recall ever hearing of Lase Med Inc: LIESH Therapy.

The plaintiff in the lawsuit is Read more »

*This blog post was originally published at Suture for a Living*

Women Wait A Long Time For Mammograms In New York City

A recent audit of nine NYC’s Health and Hospitals Corporation found City Comptroller Liu described as dangerous delays in women’s health care. It takes too long for women to get screening and diagnostic mammograms.

The 2009 audit found women at Elmhurst Hospital had the longest waits – 50 working days (that would be 10 weeks, i.e. 2.5 months) for diagnostic mammograms, on average. You can find more details here.

According to the Times’ coverage:

Ana Marengo, a spokeswoman for the city’s Health and Hospitals Corporation, which runs the public health system, said that the comptroller’s data was outdated…

At Elmhurst, she said, the wait as of December 2010 was 20 days for screening and 23 days for a general diagnostic test, as opposed to an urgent one. Read more »

*This blog post was originally published at Medical Lessons*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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