May 1st, 2011 by admin in Opinion
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The rise of prophylactic double mastectomy in women with increased risk of breast cancer has been a topic of recent discussion. In particular, this trend has been observed amongst women with the diagnosis of unilateral carcinoma in situ, or pre-invasive breast cancer. While it has been known that in women with genetic cancer syndromes, including BRCA1 and BRCA2, double mastectomy reduces risk, the efficacy of the approach is uncertain in women with other risk profiles, yet more women and surgeons seem to be doing it.
Knowing when to test, treat and act is part of art of medical practice. The ability to convey this information effectively is also an art. Both patients and doctors may have a hard time embracing watchful waiting with respect to many forms of cancer and pre-cancer. In the case of cancer of the cervix, it is known that infection with human papillomavirus (HPV) is causative in cancer development. However, only a small percentage of those infected actually go on to get cancer. Low grade dysplasia, a condition that is early in the cervical cancer development continuum, frequently spontaneously resolves without treatment. Fortunately, in the case of cervical cancer, there is now a vaccine to prevent high risk HPV infection.
“Watchful waiting” has been most discussed as a treatment strategy for prostate cancer. Read more »
*This blog post was originally published at ACP Internist*
April 13th, 2011 by AndrewSchorr in Opinion, Patient Interviews
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How is it that a person with an illness forgets to take their medicine, or refuses to get a treatment, or forgoes important monitoring? I’ve been thinking about that because someone close to me has hit that “medical fatigue” wall. There has been no effective treatment for their digestive system illness and they are tired of the prods, pokes, and special exams. They just want to live their life and “cope.”
One can understand – especially in a child or teenager. Imagine someone with diabetes. Diet, exercise, monitoring, medication. It can be so tiring. If only the illness – the boogieman or what some call “the beast” could just go away!
But it can’t and it doesn’t. And medical treatments may well be imperfect. They probably are. So do you give up? There is no “right answer,” only a right answer for you. Here are some examples: This week I am interviewing Kathy Sparks of suburban Seattle. Kathy is a nurse who was diagnosed with melanoma on her forearm. It was cut out. Then more was cut out. Then it came back. She had chemotherapy with lots of side effects. A remission followed, and then it came back again, this time in her breast. As time passed doctors gave her only months to live. Unwilling to try to fairly toxic chemo again, she spent time making peace with her impending demise. Read more »
*This blog post was originally published at Andrew's Blog*
April 12th, 2011 by Peggy Polaneczky, M.D. in Health Tips, Research
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This is the study that doesn’t end…
The longterm follow up extends…
Some people started studying hormones in menopause,
And they’ll continue publishing more data just because…
(repeat)
In yet another paper in a major journal, we hear once more from the investigators of the Women’s Health Initiative. This time it’s the long term outcomes of women who took estrogen alone, now seven years out from stopping their hormones. What new information can we learn from this extensive analysis of new data?
Nothing.
Really.
The WHI’s been telling us the same thing about ERT (Estrogen replacement therapy) and HRT (Combination estrogen/progestin therapy) since 2002, and all each subsequent study does is reinforce and expand on that initial data. Unfortunately, it will probably take a few more papers before some folks accept the results of this important study, which, though flawed, continues to inform the practice of menopausal medicine.
Allow me to summarize what we know – Read more »
*This blog post was originally published at The Blog That Ate Manhattan*
April 4th, 2011 by AnnMacDonald in Health Tips, True Stories
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One of my closest friends is a two-time breast cancer survivor. Terry (as I’ll call her) has been cancer free for eight years—long enough to be considered cured (generally defined as being in remission at least five years). But in no way is she “free” of cancer. Every abnormal blood test, every callback for another mammogram terrifies her so badly she can’t sleep until doctors rule out a recurrence. In some ways, the ongoing psychological and emotional challenges she faces have been worse than the physical treatments she endured.
I thought about Terry when I read the latest government statistics on the number of cancer survivors in this country. Nearly 12 million Americans—4% of the population—are still alive after a cancer diagnosis.
In many respects this is terrific news, and a testament to improved diagnosis and treatment options. But survivorship comes at a psychological price. We discussed these challenges at length in the Harvard Mental Health Letter, but here’s a quick look at some of the major issues. Read more »
*This blog post was originally published at Harvard Health Blog*
March 25th, 2011 by Peggy Polaneczky, M.D. in Opinion, True Stories
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A Well Blog post series in the NY Times, written by Peter Bach, MD, an attending physician at Memorial Sloan-Kettering Cancer Center in NYC, chronicle’s his experiences with his wife’s diagnosis and treatment for breast cancer.
As painful as it was to read of Bach’s wife’s breast cancer diagnosis and treatment, I found reading the comments section on the first few posts to be equally difficult. The comments ranged from supportive to downright vitriolic, as patients took the opportunity to vent at doctors and a medical system that they perceive gave Bach’s wife better access to treatment than theirs. The bitterness that comes through these comments is astonishing, but should not be. Read more »
*This blog post was originally published at The Blog That Ate Manhattan*
