Conditions

USA Today op-ed: Not all cancer screening tests lead to better treatment

My latest USA Today op-ed was published this morning.

I talk about controversies surrounding prostate and breast cancer screening, and how common sense doesn’t always apply when it comes to early cancer detection.

Here’s the bottom line: “Persuasive arguments can be made for and against screening, and the decision is a highly personal one. But patients must be better informed of the potential consequences either choice can …

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Should infants be screened for heart defects with pulse oximetry?

A simple, potentially cost-effective screening test to detect infant heart defects is rarely used in hospitals today.

Darshak Sanghavi, the chief of pediatric cardiology at the University of Massachusetts Medical School, is calling for a simple pulse oximetry test to screen infants for heart defects.

He cites a study showing that the test can detect 75 percent of critical heart defects that would have been previously missed. …

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Can aspirin with Plavix be a new option to prevent stroke in atrial fibrillation?

Those with atrial fibrillation often have to take blood thinners, like warfarin, to reduce the risk of stroke.

The problem is, warfarin requires close monitoring as well as some dietary restrictions to maintain its effectiveness and reduce the very real risk of side effects, like bleeding. It can be a significant disruption in a patient’s life, requiring regular trips to a anticoagulation clinic to have blood drawn for …

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Will the Pap smear soon be replaced by a DNA test to detect cervical cancer?

It appears the days of the Pap smear may be numbered.

A recent study from the NEJM showed that a DNA test outperformed the Pap smear in reducing deaths from cervical cancer.

This has tremendous implications worldwide, where cervical cancer continues to be a significant cause of death. Not only is the DNA test effective, it’s also inexpensive, costing around $5.

Pap smears take …

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Does jet lag really need to be cured?

With Provigil going generic in 2012, Cephalon is looking to replace that lost revenue.

Enter Nuvigil.

The drug company is trying to add a new indication, that is, “curing” jet lag, to give it a leg up over its predecessor.

That, and also drastically hiking the price of Provigil, may entice doctors to make the switch to the newer medication prior to patent expiration.

But, …

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Why do softball pitchers experience more anterior shoulder pain?

Ever see softball pitchers do their big, windmill windup prior to a pitch?

MedPage Today
finds a small study shows that it may strain their anterior shoulders more than an overhand throw.

Softball pitchers, who underwent photographic motion analysis and surface electromyography analysis of their biceps, were found to have an increased risk of injury to their biceps, caused by increased “peak biceps brachii muscle activation during …

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A cancer missed, who’s responsible for telling the patient?

Amy Tuteur’s father tragically passed away, but could it have been prevented?

She recounts the story, where, after presenting coughing up blood, her father was then diagnosed with lung cancer. However, 7 months earlier, that mass was seen on a pre-operative chest x-ray.

The urologist who ordered the test failed to inform her father, and he was later sued, but was found not to be liable.

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Poll: Should men still be screened for prostate cancer?

Screening for prostate cancer has become controversial.

The US Preventive Services Task Force concludes that the evidence is insufficient to fully endorse prostate cancer screening in younger men and they recommend against screening for prostate cancer in men over the age of 75.

And a recent study from the National Institutes of Health found that, after 7 to 10 years of follow-up, screening men with a prostate specific …

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Should we start screening women for ovarian cancer?

The answer is no.

Besides the fact that the USPSTF already recommends against ovarian cancer screening, MedPage Today reports a study concluding that screening led to a high rate of unnecessary surgery.

During four years of screening with a transvaginal ultrasound and the CA 125 biomarker , “the surgery-to-cancer ratio was 19.5:1,” meaning that almost 20 surgeries would be needed for every case of ovarian cancer …

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Are we wasting money on Alzheimer’s care?

According to the Alzheimer’s Association, now is the time to address the burgeoning Alzheimer’s crisis, especially with baby boomers in the midst of Medicare age.

Alzheimer’s dementia boosts the cost of caring for the elderly almost three-fold, from about $10,000 to $33,000 per year, and as Amy Tuteur blogs, “the report of the Alzheimer’s Association assumes that the enormous cost of Alzheimer’s care is a morally necessary burden, but …

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Should children be screened with an EKG prior to starting stimulants for ADHD?

According to some cardiologists, the answer is yes.

However, MedPage Today reports that, in a recent study presented at the American College of Cardiology meetings, the positive predictive value of such a strategy was low, and that, “To screen enough children to identify one with complex congenital heart disease or potentially life-threatening arrhythmia, the cost was $42,904.”

Pediatricians have challenged this finding, calling mass screening for children, …

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How much do we really need mammograms?

With the recent controversy surrounding prostate cancer screening, it’s now time to look at mammograms and breast cancer screening.

Like the PSA test, there is little data saying that mammograms decrease the mortality rate from breast cancer. And indeed, some of the harms of breast cancer screening are being publicized in the UK.

The number needed to treat, a statistic that is gaining increasing relevance in …

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How screening for prostate cancer can be a gamble, and why either screening or not has consequences

Should mortality be the only outcome that matters?

Dartmouth’s Gil Welch has a nice op-ed in the LA Times, discussing whether the very small benefit in lives saved from prostate cancer screening (via Schwitzer) is worth the substantial cost of side effects from overtreatment.

When talking about the recent European study finding a very small benefit to screening, Dr. Welch observes that, “Being 50 times more likely …

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Will patients accept the limitations of prostate cancer screening?

Recent studies in the NEJM have fueled the uncertainty surrounding prostate cancer screening.

The USPSTF recommends against screening men older than age 75 for prostate cancer, and gives an “I” recommendation for younger men.

Despite the controversy, there are plenty of anecdotes of men whose lives were saved by the PSA blood test. Will the lack of evidence sway men away from getting the test?

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False positive cancer screening tests doesn’t resonate in Congress

Criticizing cancer screening advocates can be a difficult thing to do.

Gary Schwtizer writes about the case of Rep. Debbie Wasserman Schultz (D-Fla.), who is introducing a new bill advocating breast cancer screening to begin earlier than the current suggested age of 40.

Ms. Wasserman Schultz was diagnosed with breast cancer at age 42, and wants “to educate the public, particularly young women and their doctors, about …

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A free colonoscopy contest, but what’s the catch?

CBS is promoting a free colonoscopy sweepstakes, which, I guess, is enough of a prize to pique a person’s interest during the recession.

But, as Dr. Wes points out, there are serious issues with the contest. First, take a look at the extensive fine print, with not-so-subtly warns that any information given will be shared with advertisers third-parties.

He also wonders about the posh Center for …

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Does a breast MRI have any benefit for patients with breast cancer?

Ah, a perfect question for comparative effectiveness research.

Surgeon Jeffrey Parks takes a look at a study looking at breast MRIs during the pre-operative workup of patients with breast cancer.

Essentially, surgical outcomes were not improved, and worse, “leads to a higher rate of unnecessary mastectomy, and is extremely expensive (about $1600 a pop, out of pocket).”

Although there are specific cases where a breast MRI …

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Are doctors doing too much cancer screening?

Screening for certain cancers, such as breast, colon, or cervical cancer, have been shown to save lives.

However, the same can’t be said for a multitude of others, including lung, pancreatic, or ovarian cancer.

Major media outlets, like NBC’s Today Show, have in the past, irresponsibly trumpeted recommendations that have no basis in evidence.

To their credit, journalism professor Gary Schwitzer says they are …

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Should I get a PSA test for prostate cancer? A new study shows that screening for prostate cancer doesn’t necessarily save lives

Prostate cancer screening is about to get a whole lot cloudier.

Published this morning in the NEJM, the results of the study by the National Cancer Institute showed that, for men who were screened with both a PSA and digital rectal exam, there was no difference when compared to men who received “usual care.”

The results confirm the suspicions that many physicians already had, namely, that screening …

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Is prostate cancer being overdiagnosed?

Recent data has suggested that we may be finding too many cases of prostate cancer.

This is important, since there are no studies suggesting that screening for early prostate cancer saves lives. In many cases, “most prostate tumors grow so slowly that had they not been screened, those men would have died of something else without the anxiety.”

In fact, the USPSTF recently recommended that men over …

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