October 12th, 2007 by Dr. Val Jones in News
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The short answer is: yes. The longer answer is that Tasmanian devils (TDs), those feisty black and white Australian marsupials, are the first to suffer from it. In an enlightening story about the plight of these little guys, I learned that they are prone to a certain type of mouth cancer that they pass to one another through biting. Now, since biting is part of their mating rituals, this cancer has spread through the TD population like wild fire, even putting them at risk for extinction.
Why am I telling you this? Because it’s quite fascinating that cancer can be contagious. Sure we know that the human papillomavirus (HPV), for example, can be spread through sexual contact and may stimulate the body to produce cervical cancer cells eventually, but this is a more direct and faster method of transmission. Researchers have found that cancer cells in the mouth of the animal doing the biting slough off in the wounds on the other animal, and the cells grow into a new cancer in the injured animal.
So you may ask – can I get cancer from a TD? Not unless YOU’RE also a TD. The reason why the cancer cells can survive in the victim is because TDs have become so genetically similar to one another that foreign cells from another animal are not recognized and attacked by their immune systems. Human immune systems would recognize the TD cells as foreign and attack and kill them quite quickly.We humans can’t even accept an organ transplant from a family member without being on strong immunosuppressive medications.
Nonetheless, this case of contagious cancer is interesting – and makes me wonder if immunosuppressed humans could one day be vulnerable to developing cancer from another person’s cells. But that risk seems rather remote. For now, we should just feel sad for our furry friends down under. I know that at least Dr. Rob, the llama lover, will understand the grief.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
October 8th, 2007 by Dr. Val Jones in Health Tips
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You’d think that all my friends were participating in breast cancer awareness month – first the abnormal mammogram scare, now a new email from a young, worried friend: “I found a lump in my breast. What should I do?”
My friend is 28 years old, with no family history of breast cancer. However, I take all lumps seriously because my husband’s sister was diagnosed in her early 30’s, after complaining of some hip pain followed by an x-ray which revealed diffuse metastases. Nonetheless, it bears repeating that a breast lump in a woman in her 20’s is highly unlikely to be cancer. For those of you out there who have found a lump in your breast, here are the statistics:
- An estimated 90% of breast lumps are benign (and that includes lumps in significantly older women).
- The number one risk factor for breast cancer is age. The risk of a woman in her 30’s having breast cancer is <0.43%. The National Cancer Institute doesn’t have per cent risks for women in their 20’s but I’m sure it’s even lower.
- Fibrocystic breast tissue occurs in up to 60% of all women, and has a lumpy texture.
- Breast cysts are fairly common, up to 7% of western females have a breast cyst at some point in their lifetimes.
- Breast lumps often occur in response to normal hormonal fluctuations in the menstrual cycle
So if you find a breast lump, you should have it evaluated, but please keep in mind that there’s a 60% chance that it’s due to harmless fibrocystic changes, and (if you’re in your 30’s) a 0.43% chance that you’ll develop cancer. Indeed, most lumps are benign at all ages.
The next step in a lump evaluation is to have an ultrasound and if you’re over 35 to also have a mammogram, and then if the clinical images warrant it, a biopsy to confirm the contents of the lump. Also keep in mind that once you’ve had a biopsy, you can expect some scarring which could be read as “abnormal” in future mammograms. So don’t be surprised if you get an abnormal mammogram later on after the biopsy.
Breast cancer awareness is very important and can save lives, but on the flip side it can also make us paranoid about our breasts. My advice would be to take any lumps seriously, but also know that it’s not cancer until proven so – and that most women have breasts with a somewhat lumpy texture, so if you don’t have any lumps, you’re technically in the minority.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
October 1st, 2007 by Dr. Val Jones in Health Tips
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A dear friend of mine sent me a panicked, cryptic email late on a Friday night: “call me immediately” (followed by her cell phone). As a doctor, I usually know that these kinds of requests are triggered my medical emergencies, so I anxiously picked up the phone and called my friend, hoping that I wasn’t going to hear some alarming story about a tragic accident.
And low and behold the story was this: “I got home from work late and picked up the mail. There was a letter in there from the radiologist’s office. It said that my mammogram was abnormal. Do you think I have breast cancer? Am I going to die?”
Remaining calm, I asked what sort of abnormality was described. She read the letter to me over the phone:
“Dear [patient],
Your recent mammogram and/or breast ultrasound examination showed a finding that requires additional studies. This does not mean that you have cancer, but that an area needs further evaluation. Your doctor has received the report of your examination. Please call us at XXX to schedule the additional examinations.”
I knew immediately that this was a form letter (heck the letter didn’t even distinguish between whether or not my friend had had a mammogram or an ultrasound) and it made me angry that it had frightened her unnecessarily. I knew that as many as 40% of women who have mammograms have some sort of “finding” that requires further testing. Usually it’s because the films are too dark or too light, the breasts are particularly large or dense, or there is some cyst, calcification, lymph node, or shadow that the radiologist picks up. And in a litigious society, a hint of anything out of the ordinary must be reported as an abnormal “finding” until proven otherwise.
I did my very best to reassure my friend – to tell her that if the radiologist were truly concerned about what he or she saw on the mammogram s/he would have called the physician who ordered the test right away. Receiving a vague letter like this is reassuring, because it’s an indication of a low index of suspicion for a malignancy. I also told my friend that if a true mass were found on the mammogram, that a biopsy of that mass still has an 80% chance of being normal tissue.
But even though I did my very best to reassure her, my poor friend didn’t sleep well that night, and worried all weekend until she could speak to her physician on Monday. As I thought about her experience, and the unnecessary fright that she was given… I began to wonder about how common this experience must be. How many other women out there have lived through such anxiety?
Personally, I think that women who get mammograms should be warned up front that there is a high chance that the radiologist will find something “abnormal” on the test, and that these abnormalities usually turn out to be any number of typical breast characteristics. They should be told not to worry when they receive a letter about the abnormality, but come back for further testing in the rare event that the finding is concerning.
I decided to do a little research about this phenomenon (women receiving scary letters out of the blue about their mammogram results) and interviewed Dr. Iffath Hoskins (Senior Vice President, Chairman and Residency Director in the Department of Obstetrics and Gynecology at Lutheran Medical Center in Brooklyn, N.Y.) about her experiences.
Please listen to the audio file for the full conversation. I will summarize her opinions here:
Q: How common are abnormal mammograms?
Mammograms are considered “abnormal” in some way in up to 40% of cases.
Q: What sorts of things are picked up as abnormal without being true pathology?
Overlapping tissues in women with larger or heavier breasts, fibrocystic breast tissue, calcium deposits or the radiologist doesn’t have the last mammogram to compare the new one to and sees some potential densities.
Q: What happens next when a woman has an abnormal mammogram?
It may take a week or two for the patient to get scheduled for follow up tests. Usually the physician will choose to either repeat the mammogram with targeted views of the area in question, request a breast ultrasound, biopsy the mass, or remove the concerning portion of the breast tissue surgically.
Q: When would a physician choose a biopsy?
A biopsy is indicated if the mammogram and follow up tests all are consistent with the appearance of a concerning lesion. Sometimes the physician will do a biopsy on a lump if a woman says that it’s unusual, new, or tender and the mammogram result is equivocal.
Q: What percent of biopsies confirm a malignancy?
It varies from physician to physician because some have a lower threshold for performing biopsies (so therefore the percent of biopsies that are malignant is lower). But on average only 10% of biopsies pick up an actual cancer.
Q: What does a radiologist do when he or she finds an abnormality on a mammogram?
First of all, the patient must be notified of the abnormality. Secondly, the radiologist reports the abnormality to the referring physician, usually by fax. They do it either in batches, or one at a time. If the person reading the film has a serious concern about the breast tissue – or if it appears to have the characteristics of a malignancy, the radiologist will personally call the referring physician right away.
Q: What advice would you give to a woman who receives a letter in the mail indicating that she’s had an abnormal finding on her mammogram?
Please try not to be concerned yet. Wait for the doctor to fully evaluate the mammogram and do further testing before you make any assumptions about the diagnosis. Although it’s almost impossible not to feel anxious, you must understand that the vast majority of “abnormal findings” on a mammogram are NOT cancer.
Listen to the full interview here.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
September 24th, 2007 by Dr. Val Jones in News
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The oncology community bid farewell to one of its greatest leaders last week, Dr. Marty Abeloff. Marty was a dear colleague of Dr. Avrum Bluming (a guest blogger and friend of Dr. Val & The Voice of Reason) and Av was kind enough to write this obituary to honor him:
On September 14, 2007, Marty Abeloff died.
An intelligent, gracious, caring and supportive human being, he brought all those qualities to his roles as physician, mentor, educator, administrator, and friend.
He was a Phi Beta Kappa graduate of Johns Hopkins and an Alpha Omega Alpha graduate of Johns Hopkins Medical School. He did his house staff/fellowship training at the University of Chicago, the National Cancer Institute, Harvard, the New England Medical Center, and Johns Hopkins. At the time of his death, he was Professor of Medicine and Director of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University. He was a past President of the American Society of Clinical Oncology, past Chairman of the Oncology Drugs Advisory Committee of the Food and Drug Administration, past Chairman of the Board of Scientific Counselors to the National Cancer Institute’s intramural division of clinical sciences, and past Chairman of the Breast Cancer Committee of the Eastern Cooperative Oncology Group. He was the lead Editor of Clinical Oncology, a comprehensive textbook, now in its third printing, Editor of Current Opinion in Oncology, former Associate Editor of the Journal of Clinical Oncology, and founding Editor in Chief of Oncology News International, a wonderfully informative periodical, a position he established and occupied since 1992.
He was held in high esteem by his peers, and beloved by his colleagues, co-workers, patients, students, family members and friends. Patients held on to his phone number long after they finished treatment, and those of us seeking advise in the management of our own patients never hesitated to call upon his help. He was always available and always helpful.
Any individual looking to fashion a life and career distinguished by accomplishment and filled with love could find no finer role model.
Avrum Z. Bluming, MD, MACP
Clinical Professor of Medicine
University of Southern California
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
September 23rd, 2007 by Dr. Val Jones in Health Tips
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If you’re one of those unlucky souls who is easily nauseated by riding in planes, trains, and automobiles – and forget about boats, they’ll keep you hanging over the rail for hours – then welcome to the motion sickness club. You’ve probably already read about your treatment options, but you may not find any of them completely satisfying.
Motion sickness (like car sickness, sea sickness, etc.) is caused by an uncoupling of input from the eyes, ears, and joint position-sensing nerves throughout your body. In other words, your brain becomes confused by conflicting messages about where your body is in space. If you’re sitting in a chair, your brain expects it to be fixed and not to move – but then if that chair is in a car or on a boat, the movement doesn’t make sense to it, and you become dizzy and nauseated. The details of the science behind motion sickness is quite complex – and there are many different approaches to treating and preventing it.
In terms of medications – antihistamines such as Benadryl (diphenhydramine), Dramamine, Antivert (meclizine), and Phenergan and anticholinergics like Scopolamine may be the most commonly used. They have varying sedative side effects which can be very inconvenient for those who need to be alert and active immediately after they get out of the car, train, boat, etc.
Some people have used Zofran (ondansetron) for motion sickness prevention – and although this drug is only approved for the treatment of nausea side effects caused by cancer chemo and radiation therapy, it has a unique mechanism of action for preventing nausea. It works by blocking serotonin receptors in the brain (and perhaps in the gut) to head off motion sickness. It does not produce drowsiness as a side effect, and is generally well tolerated. Unfortunately, it is very expensive (about $50 per pill – without insurance).
Personally, I try to stay away from medications as much as I can (they always have the potential for unwanted side effects) – but if you’re really struggling with motion sickness and have exhausted all your options, you might want to ask your doctor about Zofran. I must admit that for me (someone who gets ill just looking at amusement park rides), a little bit of Zofran has radically improved my traveling difficulties. In fact, I’m writing this blog post from a seaside vacation spot in sunny California… and I have no worries about the flight home, choppy air or not. Bring on the deep sea fishing, parasailing, and jet skiing – I have no fear, Zofran is here!This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
